Changes in hip muscle strength after proximal femoral fracture in elderly women

Ivanova, Natalja; Aibast, Herje; Gapeyeva, Helena; Kums, Tatjana; Märtson, Aare

doi:10.12697/akut.2011.17.06

Cited by 6 publications

(8 citation statements)

References 19 publications

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“…N. Ivanova et al found that maximum voluntary isometric force generated in knee and hip muscles for the fractured leg was markedly increased at one week and 6 months postoperatively. 9 In our study we found that two patients (4.4%) had initial abductor power grade 1. 29 patients (64.4%) had grade 2 power and rest had grade 3 muscle power.…”

Section: Discussionmentioning

confidence: 45%

Abductor weakness in intertrochantric fractures operated with PFN and its management

Kundu¹,

Wale²,

Phuljhele³

et al. 2020

IJOS

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Introduction: Intertrochanteric hip fractures are common with advancing age. PFN is now increasingly used to fix unstable intertrochantric fractures however it does not fix greater trochanter. Gluteus medius and gluteus minimus attach to greater trochanter, hence abductor weakness is a likely consequence. In this study we measured the incidence of post operative abductor weakness (trendelenberg gait) and result of targeted physiotherapy on it. Materials and Methods: Between September 2014 and august 2016, 45 patients with unstable intertrochanteric fractures underwent proximal femoral nailing in the Department of Orthopaedics Pt. J. N. M Medical College and Dr. B.R.A.M Hospital, Raipur (C.G.). The patients included in this study were more than 18 years of age with unstable fractures classified according to Modified Evans classification type 3, 4 and 5 with the duration of trauma less than 3 weeks. The functional assessment was made using Mckay criteria through analysis of abductor muscle strength. Result: Immediate Postoperative muscle power was Grade 1 (02 pt.), Grade 2 (27 pt.), and Grade 3 (14 pt.). At 6 months follow up only 02 patients had grade 4 power (due to varus malunion) rest all had muscle power Grade 5. In this study we found that only 2 out of 45 patients (4.4%) had initial abductor power grade 1, grade 2 -64.4% and rest had grade 3 muscle power. Only 2 patient (due to varus malunion) had grade 4 power at 6 months follow-up rest all patients regained power grade 5. Conclusion: Abductor weakness and trendelenberg gait are fairly common in patients treated with PFN and this complaint is often overlooked. Abductor muscle power should be properly assessed post-operatively and physiotherapy for abductor weakness is essential for complete rehabilitation of patients.

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Section: Discussionmentioning

confidence: 45%

Abductor weakness in intertrochantric fractures operated with PFN and its management

Kundu¹,

Wale²,

Phuljhele³

et al. 2020

IJOS

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“…Similarly if the entry site is through pyriformis fossa it may disturb the abductor musculature [20] . Rudy Rendle et al found that those implants that require excessive reaming of the greater trochanter to proximal aspect of implant may cause abductor muscle wasting and Trendelenburg gait (10). Many studies have been done in which the PFN has been reinforced with GT fixation devices.…”

Section: Discussionmentioning

confidence: 99%

“…This is consistent with the observational studies done by N Ivanova et al [23] In immediate post-operative period modified Mckays criteria is useful to assess the abductor weakness and should be routinely used Strengthening exercises are the key to the functional improvement of patients along with gait or ADL training or proprioception and others like motor stimulation apparatuses and analgesia. Limitations of mobility are quite common and are partially related to the lack of strength and muscle power [24] . The goal of physical therapy in postoperative treatment of patients with a proximal femoral fracture should be to increase muscle strength, and to improve ambulation and efficiency, thus enabling the elderly patient to become independent.…”

Section: Discussionmentioning

confidence: 99%

“…It is important to know that the residual life time risk of proximal femoral fracture from age of 60 is 44% for women and 25% for men [6] ; 30% of the patients die [7] , 50% of survivors need assistance in walking and 90% need assistance to climb stairs after 1 year [8,9] . One of the most common outcomes in hip fractures is mobility limitation due to deficits of lower limb muscular strength [10] . Studies in elderly adults have demonstrated that the muscle strength deficit is extremely large after Intertrochanteric fractures without good rehabilitation [11] .…”

Section: Introductionmentioning

confidence: 99%

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Abductor muscle weakness and the role of targeted physiotherapy in intertrochanteric fractures treated with PFN

Pv¹,

Dhanda²,

Inamdar³

et al. 2021

Int. J. Orthop. Sci.

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Introduction: Intertrochanteric hip fractures are common with increasing age.Unstable intertrochanteric fractures are now commonly fixed using PFN, however it cannot engage greater trochanter on its own. Gluteus Medius and gluteus minimus (main abductors) attach to greater trochanter, hence abductor weakness is a likely consequence especially in comminuted fractures. In this study we measured the incidence of post-operative abductor weakness and result of targeted physiotherapy on it. Materials and Methods: 135 patients with unstable intertrochanteric fractures underwent proximal femoral nailing at our hospital. The patients included in this study were more than 18 years of age with unstable fractures classified according to Modified Evans classification type 3, 4 and 5 with the duration of trauma less than 3 weeks. The functional assessment was made using Modified McKay criteria through analysis of abductor muscle strength. All patients underwent a pre-determined physiotherapy as per protocol. Result: Immediate post-operative muscle power was Grade 1-(09 pt.), Grade 2 (39 pt.), Grade 3 (43 pt.) and Grade 4 (43 pt.). Most of the patient improved their muscle power grade at 12 weeks with only 09 patients with grade 2 and 23 patients with grade 3 power. At final months follow up only 08 patients had grade 3 power and only 6 patients had grade 4 power while the rest had muscle power grade 5.In our study excellent score was seen in 87 patients (83%), good in 12 patients (12%) and poor only 7 patients (5%) at 6 months, as per Modified Mckay criteria. Conclusion: Abductor weakness and Trendelenburg gait are surprisingly common in patients treated with PFN and this complaint is often overlooked. Correct surgical method and targeted physiotherapy can help alleviate this problem.

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“…Proximal femoral fractures (PFFs) frequently occur in the elderly population, 1 which represent a medical and socioeconomic burden, with a reported global annual incidence of approximately 1.3 million. 2 This number is predicted to increase to about 6 million by the year 2050. 3 Using cephalomedullary nails (CMNs) or the so-called proximal femoral nails (PFNs) for treating these fractures became the gold standard approach since its introduction in the 1980s.…”

Section: Introductionmentioning

confidence: 99%

How to Assess Proximal Femoral Shortening after Nailing of Proximal Femoral Fractures? A Short Review

Khalifa

Khaled

ElHawary

et al. 2021

International Journal of Recent Surgical and Medical Sciences

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Proximal femoral fractures (PFFs) are considered one of the most frequent situations faced by orthopaedic surgeons. Many lines of management had been described. Although management of PFFs with cephalomedullary nails (CMNs) is now considered the gold standard with many mechanical and biological advantages, this technique may have some disadvantages such as residual peritrochanteric pain, limping, limited walking distance, and difficulty with stairs. These complications may be attributed to fracture malreduction with shortening, which may result in either malunion or nonunion and ultimately implant failure. The resultant proximal femoral shortening (PFS) with alteration of the proximal femoral mechanics may affect both the hip abductor function and the daily patient activities. The purpose of this short review is to discuss the assessment and secondary effects of PFS after treating femoral fractures with CMNs.

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Changes in hip muscle strength after proximal femoral fracture in elderly women

Cited by 6 publications

References 19 publications

Abductor weakness in intertrochantric fractures operated with PFN and its management

Abductor weakness in intertrochantric fractures operated with PFN and its management

Abductor muscle weakness and the role of targeted physiotherapy in intertrochanteric fractures treated with PFN

How to Assess Proximal Femoral Shortening after Nailing of Proximal Femoral Fractures? A Short Review

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