Postoperative Restoration of Muscle Strength After Intramedullary Nailing of Fractures of the Femoral Shaft

Danckwardt-Lillieström, G; Sjögren, S.

doi:10.3109/17453677608998980

Cited by 37 publications

(12 citation statements)

References 2 publications

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“…As with other authors, we have found a slight increase in the strength of the uninjured limb with time 4 with improvement of up to 25% being noted, but this increase tended to reach a plateau early. Our study also confirmed that there is a high correlation between peak torque, total work and mean power between the two test speeds.…”

Section: Discussionsupporting

confidence: 62%

“…There have been few reports on the recovery of muscle strength after fractures of the lower limb. Of these, most have been concerned with muscle recovery after fractures of the femur rather than of the tibia, [1][2][3][4] but the latter are much more common and tend to affect younger patients, many of whom are keen to return to sports and other activities. 5 We have examined the recovery of muscle groups of the lower limb after fracture of the tibial diaphysis with particular reference to the age of the patient, the mechanism of injury and the type of fracture.…”

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confidence: 99%

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Analysis of muscle function in the lower limb after fracture of the diaphysis of the tibia in adults

Gaston

Will

McQueen

et al. 2000

The Journal of Bone and Joint Surgery. British volume

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W e examined the recovery of power in the muscles of the lower limb after fracture of the tibial diaphysis, using a Biodex dynamometer. Recovery in all muscle groups was rapid for 15 to 20 weeks following fracture after which it slowed. Two weeks after fracture the knee flexors and extensors have about 40% of normal power, which rises to 75% to 85% after one year. The dorsiflexors and plantar flexors of the ankle and the invertors and evertors of the subtalar joint are much weaker two weeks after injury, but at one year their mean power is more than that of the knee flexors and extensors.Our When treating a severely-injured limb the final outcome is usually determined by the extent of the injury to the soft tissues. There have been few reports on the recovery of muscle strength after fractures of the lower limb. Of these, most have been concerned with muscle recovery after fractures of the femur rather than of the tibia, 1-4 but the latter are much more common and tend to affect younger patients, many of whom are keen to return to sports and other activities. 5 We have examined the recovery of muscle groups of the lower limb after fracture of the tibial diaphysis with particular reference to the age of the patient, the mechanism of injury and the type of fracture. Patients and MethodsBetween June 1994 and November 1996, 130 patients with isolated fractures of the tibia and fibula treated by intramedullary fixation were entered into the study. We excluded multiply-injured patients and those with more than one fracture in the limb, since their functional recovery would be affected by the extent and severity of other injuries, and patients who were unable to co-operate with the study protocol or who lived outside the local area. Of the 130, 30 failed to attend for follow-up, leaving 100 in the study. There were 81 men and 19 women with a mean age of 30.6 years (13 to 64). There were 87 closed and 13 open fractures. According to the AO classification 6 67 fractures were type A, 22 were type B and 11 were type C. Of the 87 closed fractures, eight were Tscherne 7 C0, 63 were C1, 14were C2 and the remaining two were C3. All fractures were classified by one consultant (CCB) to avoid interobserver variation. Open fractures were treated by debridement and primary nailing followed by re-exploration of the wound 36 to 48 hours after injury, with soft-tissue cover being carried out at the second procedure or shortly after. Closed fractures were treated by primary nailing. 8,9 A reamed GrosseKempf nail was used in all cases. Physiotherapy was started on the day after operation and weight-bearing was allowed as soon as it could be tolerated. Muscle function was assessed using a Biodex dynamometer (Biodex Medical Systems Inc, New York) at 2, 6, 10, 14, 18, 26, 39 and 52 weeks after injury to determe isokinetic peak torque, total work and the average power for knee flexion and extension, ankle dorsiflexion and plantar flexion and subtalar inversion and eversion. Each test consisted of an active period of warm-up followed by six ...

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Section: Discussionsupporting

confidence: 62%

mentioning

confidence: 99%

Analysis of muscle function in the lower limb after fracture of the diaphysis of the tibia in adults

Gaston

Will

McQueen

et al. 2000

The Journal of Bone and Joint Surgery. British volume

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“…In addition, this technique requires inevitable surgical dissection through the hip abductor and exorotator muscles and, last but not least, at implant removal, major surgical tissue dissection may cause considerable problems. The above outlined problems may, ultimately, result in reduced daily function accompanied by residual pain, stiffness, muscle weakness with discrete Duchenne limp, and some loss of endurance [13][14][15][16][17].…”

Section: Introductionmentioning

confidence: 99%

Intramedullary femoral nailing through the trochanteric fossa versus greater trochanter tip: a randomized controlled study with in-depth functional outcome results

Moein

Duis

Oey

et al. 2011

Eur J Trauma Emerg Surg

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“…Another series of 32 patients with femoral fractures had 41% of patients with trochanteric pain and high incidences of abductor weakness and functional deficits. Hip abductor weakness may persist for as much as 2 years [6]. A cadaveric nailing study showed substantial soft tissue damage occurred when using traditional entry sites [8].…”

Section: Discussionmentioning

confidence: 99%

“…Clinically, persistent hip pain and limp are not uncommon after such procedures, and some authors suggest a major component of this pain is damage to the abductor tendons [1,6,7,12]. Bain and colleagues reported a 40% incidence of persistent trochanteric pain after femoral nailing [1].…”

Section: Introductionmentioning

confidence: 97%

Anatomy of the Greater Trochanteric ‘Bald Spot’: A Potential Portal for Abductor Sparing Femoral Nailing?

Gardner

Robertson

Boraiah

et al. 2008

Clin Orthop Relat Res

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Soft tissue injury occurs when using a piriformis portal for femoral nailing. Standard trochanteric portals also can injure the gluteus medius and external rotator tendons, which may be a source of hip pain after nailing. On the lateral facet of the greater trochanter, a "bald spot" may exist that is devoid of tendon insertion. This may be a potential portal for intramedullary nail insertion. We defined the dimensions and location of this region. Cadaveric specimens were dissected to expose the tendon insertions on the greater trochanter. A computer navigation system was used with a stylus and bone morphing to determine the tendon insertions and bald spot anatomy. The greater trochanteric bald spot is covered by the subgluteus medius bursa and has no tendon insertions. Its center lies 11 mm distal to the tip of the greater trochanter and 5 mm anterior to the midline. The shape is ellipsoid with a diameter of 21 mm. This region is large enough to accommodate the size of most nailing system reamers without tendon footprint infringement. Use of this modified entry site may reduce soft tissue injury with nailing procedures and minimize subsequent hip pain.

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Postoperative Restoration of Muscle Strength After Intramedullary Nailing of Fractures of the Femoral Shaft

Cited by 37 publications

References 2 publications

Analysis of muscle function in the lower limb after fracture of the diaphysis of the tibia in adults

Analysis of muscle function in the lower limb after fracture of the diaphysis of the tibia in adults

Intramedullary femoral nailing through the trochanteric fossa versus greater trochanter tip: a randomized controlled study with in-depth functional outcome results

Anatomy of the Greater Trochanteric ‘Bald Spot’: A Potential Portal for Abductor Sparing Femoral Nailing?

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