Mobility after Proximal Femoral Fracture: The Relevance of Leg Extensor Power, Postural Sway and Other Factors

Abstract

We studied 40 previously healthy women (median age 83 years 90% central range 77-90) 1 week after surgical fixation of their proximal femoral fracture to establish the significance of leg extensor power, postural sway, age, pre-injury mobility and fracture type in recovery of walking and stair-climbing ability. Subjects demonstrated a range of walking and stair-climbing abilities. Those not mobile all had sway greater than 40.9 cm/1 min and were more likely to have suffered a trochanteric fracture (p < 0.05). These subjects were not the oldest or those with the worst pre-injury mobility, but did report much greater pain (p < 0.05). Multiple linear regression revealed leg extensor power in the fractured leg (LEPf) to be the most important determinant of walking speed (R2 0.40, p < 0.001) and stair climbing time (R2 0.33, p < 0.002). LEPf was less than in the uninjured leg (p < 0.001), and accounted for only 30% of the total power output. LEPf was determined by pain, and not pre-injury mobility or fracture pattern. These findings have implications for the development of rehabilitation programmes.

Association between Acute Postoperative Pain and Recovery of Independent Walking Ability after Surgical Treatment of Hip Fracture

“…24,25) However, the results of the present study show that the ratio of bilateral knee extension muscle strength to body weight is a factor associated with independent walking after surgery for hip fracture. The gait pattern of a patient with femoral neck fracture is asymmetric, with more load placed on the nonoperative lower limb.…”

“…Feldt and Oh identified the severity of acute postoperative pain among patients with hip fracture as being predictive of functional outcomes at 2 months postsurgery. 24) Morrison et al reported a significant association between postoperative pain at rest after hip fracture treatment among older individuals (411 patients, median age of 82 years) and prolonged length of hospital stay, delayed ambulation, and functional impairment at 6 months postsurgery. 13) Our results extend these findings, indicating that the intensity of acute postoperative pain was predictive of the time to recovery of independent gait during the rehabilitation period after surgical hip fracture treatment.…”

“…The short follow-up duration of our study limited comparisons of the effects of acute pain on functional recovery identified in the current study with those described in previous studies. 13,24) Postoperative acute pain is a physiological response to a noxious stimulus. 25) Recent research has demonstrated that a variety of chronic clinical conditions, such as rheumatoid arthritis and osteoarthritis, can contribute to higher perceived pain intensity through central sensitization.…”

Body Weight–Supported Treadmill Training for Patients With Hip Fracture: A Feasibility Study

“…6,7 Mobility may be linked to lower extremity function; power of the leg extensors in the fractured leg has been positively associated with walking speed and stair-climbing time among patients after hip fracture. 8,9 Current strategies for training independent ambulation involve muscle strengthening, weight shifting, and balance exercises, as well as walking with or without assistive aids, generally in the hallways of inpatient units. Patients with hip fracture may not be allowed to bear full body weight initially, 10 which may be difficult for rehabilitation providers to control during walking exercises.…”

Fractura osteoporótica de cadera: Factores predictivos de recuperación funcional a corto y largo plazo

“…La existencia de dolor en la cadera determina una peor extensión de la pierna fracturada y esto limita, a su vez, la velocidad de Población seleccionada en el estudio: *=no institucionalizada; * 1 =sana y no institucionalizada; * 2 =fractura trocanterea; * 3 =sana con fractura subcapital; * 4 =al alta en unidad de rehabilitación;* 5 =Sin demencia. ABVD=Actividades básicas de la vida diaria TABLA I la marcha y prolonga el tiempo empleado para subir escaleras tras la fractura (115). Uno de los trabajos analizados encuentra que el no haber sufrido una caída importante es predictor de buena recuperación para las actividades básicas de la vida diaria (8).…”