Author ORCID Identifier
https://orcid.org/0000-0003-1992-3123
Date Available
8-8-2026
Year of Publication
2024
Document Type
Doctoral Dissertation
Degree Name
Doctor of Philosophy (PhD)
College
Education
Department/School/Program
Kinesiology and Health Promotion
Advisor
Dr. Brian Noehren
Co-Director of Graduate Studies
Dr. Michael A. Samaan
Abstract
Ankle Fractures account for approximately 9% of all lower extremity fractures and incidence continues to rise. Up to 53% of ankle fractures require surgical intervention. Impaired physical function is one of the most reported and observed lasting effects of surgically repaired ankle fractures. Additionally, limited physical capacity and function have been identified as the primary threats to health-related quality of life after surgical repair of ankle fractures. These impairments to physical capacity and functionality can last longer than 5 years after surgery. Since surgery typically successfully restores stability and congruency of the talocrural joint, these poor long-term outcomes are an indictment of current postoperative rehabilitation practices. Unsuccessful restoration of full physical function could be due to the lack of objectively defined physical impairments after surgery. Previous research has identified impaired physical function and asymmetrical lower extremity performance particularly at the ankle and knee after surgery. To date, there has been little investigation into specific lower extremity kinetic and kinematic impairments and how they may relate to the physical performance tasks after surgical repair of ankle fractures. Previous evidence suggests that approximately 61% of patients participate in formal physical therapy treatment after surgical repair of ankle fractures. These treatment plans typically begin up to 3 months after surgery and conclude approximately 6 months after surgery. To our knowledge, no studies have focused on identifying objective physical impairments during functional mobility tasks from 3 to 6 months after surgical repair of ankle fractures. The purpose of this dissertation was to identify impairments of lower extremity kinematics, kinetics, and strength and determine their relationships with physical function. We sought to identify these impairments within the timeframe patients may be participating in formal physical therapy treatment programs. Each study in this dissertation includes the same cohort of 20 patients who sustained unstable ankle fractures that were surgically fixed. Participants were evaluated 3 months after surgery and again 6 months after surgery. They completed the same battery of functional mobility and strength assessments at each timepoint. Three-dimensional motion and ground reaction forces were analyzed during ambulation, step navigation, and chair transfers. Additionally, isometric strength of ankle plantarflexion and knee extension were evaluated. Finally, performance outcomes including the Timed up and go, the 40-meter fast-paced walk test, the 11-stair climb test, and the 30-second chair stand test were assessed. These studies results indicate that there are involved lower extremity kinetic, kinematic, and strength impairments 3 months after surgical repair of ankle fractures. Some of these impairments are associated with performance outcome scores. Finally, performance outcomes assessed at 3 months postoperative are associated with some ankle and knee kinetic, kinematic, or strength impairments that persist 6 months after surgery. Understanding of these objective impairments can be useful for clinicians to design more specific rehabilitation programs when attempting to restore functionality and physical capacity after surgical repair of ankle fractures.
Digital Object Identifier (DOI)
https://doi.org/10.13023/etd.2024.332
Recommended Citation
Brightwell, Benjamin, "BIOMECHANICS, STRENGTH, AND PHYSICAL FUNCTION AFTER SURGICAL REPAIR OF ROTATIONAL ANKLE FRACTURES" (2024). Theses and Dissertations--Kinesiology and Health Promotion. 116.
https://uknowledge.uky.edu/khp_etds/116
