Leveraging Wearables to Transform Patient Recovery after Tibial Fracture Surgery

Over 490K Americans fracture their tibia (shinbone) yearly, and require surgery. However, patient recovery 1 year following surgery is poor and inconsistent with 2/3 of patients reporting an inability to do pre-injury leisure activities and 1/2 still not having recovered enough to return to work. A key role of clinicians after tibial shaft fracture surgery is to prescribe a rehabilitation exercise program that exposes each patient’s tibia to increasing forces to gradually recover the ability to do pre-injury activities. However, major limitations holding back progress in the field are the lack of knowledge on how much tibial force patients experience during daily activities, in their rehabilitation program throughout recovery, and how tibial force early in recovery affects longer-term functional recovery. The overarching goal of this work is to generate the knowledgebase and tools that will enable us to reimagine and elevate the standard of care for individuals after tibial shaft fracture surgery, by monitoring and managing tibial bone forces in daily life. We propose to accomplish the overarching objective through the following aims. Aim 1: Characterize tibial bone force in patients at home over the first year following surgery. Aim 2: Create the first clinical reference guide that ranks tibial forces during commonly- prescribed rehabilitation exercises. Aim 3: Assess if higher tibial forces during early recovery correspond with better functional outcomes at 6- and 12-month follow up. If our hypothesis is supported then these results would inform new clinical guidelines (target bone force thresholds) and biofeedback interventions to monitor and promote healthy bone forces in recovery. This wearable monitoring paradigm has unparalleled potential to be adapted to elevate care for recovery from numerous musculoskeletal disorders.