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Vasilopoulou A, Karampitianis S, Chloros GD, Giannoudis PV. Incidence of complications and functional outcomes following segmental femoral shaft fractures: a critical review of the literature. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY & TRAUMATOLOGY : ORTHOPEDIE TRAUMATOLOGIE 2024:10.1007/s00590-024-04065-8. [PMID: 39150553 DOI: 10.1007/s00590-024-04065-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/10/2023] [Accepted: 07/31/2024] [Indexed: 08/17/2024]
Abstract
BACKGROUND Although segmental femoral shaft fractures (SFSF) are very challenging to manage, there has been no critical evaluation of the current practices and outcomes. The aim of this study is to evaluate their characteristics, management trends, outcomes, and complications. METHODS A literature search was conducted via the SCOPUS, Embase (via SCOPUS) and MEDLINE (via PubMed) between 1995 and 2023. Studies were included if they reported patient demographics, mechanism of injury, classification of fractures, associated injuries, type of management, outcomes, and complications. EXCLUSION CRITERIA only diaphyseal fractures were included and proximal and distal femoral fractures were excluded from this study. RESULTS Overall, 22 studies met the inclusion criteria reporting on 313 patients. Mean age was 36.2 years with male-female ratio of 4.8 to 1. The majority were high-energy fractures secondary to road traffic accidents and 16% were open. The most commonly associated injuries included chest injury (27%) and lower leg fractures (24%). Treatment consisted of intramedullary nailing (IMN) (72%), plating (22%) or both combined (6%). Outcomes reported: good in 70%, fair in 10%, excellent in 19% and poor in 2% of cases. Mean time to union was 20 weeks. Complications are reported in 24% of cases, with most common delayed union (5%) and non-union (4%). CONCLUSION SFSF are high-energy fractures occurring most commonly in young males, are open in 16% of cases and have significant associated injuries. In their overwhelming majority, IMN is the mainstay of treatment. The expected outcome is generally good in 70% of cases, although not devoid of complications in 24% of cases and patients must be aware of this during the consent process.
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Affiliation(s)
- Anastasia Vasilopoulou
- Orthopaedic Surgery Working Group, Society for Junior Doctors, Athens, Greece
- Trauma and Orthopaedic Department, Korgialenio-Benakio Hellenic Red Cross Hospital, Athens, Greece
| | - Spyridon Karampitianis
- Orthopaedic Surgery Working Group, Society for Junior Doctors, Athens, Greece
- Department of Surgery, Spital Walenstadt, Kantonsspital Graubünden, Spitalstrasse 5, 8880, Walenstadt, St Gallen, Switzerland
| | - George D Chloros
- Orthopaedic Surgery Working Group, Society for Junior Doctors, Athens, Greece
- Orthopaedic Surgery & Traumatology, University General Hospital "ATTIKON", Medical School, National and Kapodistrian University of Athens, 12462, Athens, Greece
- Private Practice, Athens, Greece
| | - Peter V Giannoudis
- Academic Department of Trauma and Orthopaedics, School of Medicine, Clarendon Wing Leeds General Infirmary, University of Leeds, Floor D, Great George Street, Leeds, LS1 3EX, UK.
- NIHR Leeds Biomedical Research Center, Chapel Allerton Hospital, Leeds, UK.
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Brightwell BD, Van Wyngaarden JJ, Samaan MA, Matuszewski PE, Jacobs CA, Noehren B. Factors Associated With Long-Term Quadriceps Muscle Function After Surgical Fixation of Lower Extremity Fractures. Phys Ther 2023; 103:pzad108. [PMID: 37581587 PMCID: PMC11009693 DOI: 10.1093/ptj/pzad108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Revised: 04/18/2023] [Accepted: 06/12/2023] [Indexed: 08/16/2023]
Abstract
OBJECTIVE The long-term performance of the quadriceps femoris muscle and physical function following surgical repair of a lower extremity fracture remains largely undefined. The purpose of this study was to investigate between-limb differences in quadriceps performance 12 months after surgical fixation of a lower extremity fracture. It was hypothesized that the injured limb would be significantly weaker, have a lower rate of torque development (RTD), and that there would be a reduced step-down performance compared to the uninjured limb 12 months after surgery. Additionally, this study sought to identify demographic, surgical, and psychological factors associated with poor quadriceps function 12 months after surgery. METHODS Quadriceps performance was measured bilaterally in 95 participants (49 female), aged 42 (SD = 14.5) years, 12 months after surgical fixation of a lower extremity fracture. Isometric quadriceps strength and RTD were quantified using isometric dynamometry, and a timed step-down test was used to evaluate quadriceps performance. Independent predictor variables from the time of surgery were extracted from participants' medical records. Kinesiophobia was screened at the time of testing. Wilcoxon signed-rank tests and linear regression analyses were used to assess between-limb differences in quadriceps performance and to determine factors associated with quadriceps performance 12 months after surgery. RESULTS Significant between-limb differences in each measure of quadriceps performance were identified (peak torque involved: 1.37 [0.71] Nm × kg-1; uninvolved: 1.87 [0.74] Nm × kg-1; RTD involved: 4.16 [2.75] Nm × kg-1 × s-1; uninvolved: 6.10 [3.02] Nm × kg-1 × × -1; and single-leg step-downs involved: 12.6 [5.0]; uninvolved: 21.7 [14.8]). Female biological sex, external fixation, and kinesiophobia at 12 months were associated with reduced after-surgery quadriceps performance outcomes. CONCLUSION Quadriceps performance is impaired 12 months after surgical repair of a lower extremity fracture, particularly in female participants, in cases requiring external fixation, and in those with higher kinesiophobia 12 months after surgery. IMPACT Because long-term quadriceps weakness negatively impacts functional mobility, targeted strengthening should be emphasized after surgical repair of lower extremity fracture.
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Affiliation(s)
- Benjamin D Brightwell
- Department of Physical Therapy, University of Texas Medical Branch at Galveston, Galveston, Texas, USA
- Department of Kinesiology and Health Promotion, University of Kentucky, Lexington, Kentucky, USA
| | - Joshua J Van Wyngaarden
- Army-Baylor University Doctoral Program in Physical Therapy, Department of Physical Therapy, Baylor University, San Antonio, Texas, USA
| | - Michael A Samaan
- Department of Kinesiology and Health Promotion, University of Kentucky, Lexington, Kentucky, USA
| | - Paul E Matuszewski
- Department of Orthopedic Surgery & Sports Medicine, University of Kentucky, Lexington, Kentucky, USA
| | - Cale A Jacobs
- Mass General Brigham Sports Medicine, Brigham and Women’s Hospital, Boston, Massachusetts, USA
| | - Brian Noehren
- Department of Physical Therapy, University of Kentucky, Lexington, Kentucky, USA
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Baheti NC, Harjpal P. Perks of Rehabilitation in a Patient Who Underwent Total Hip Replacement Surgery Twice: A Case Report. Cureus 2023; 15:e46137. [PMID: 37900535 PMCID: PMC10612534 DOI: 10.7759/cureus.46137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Accepted: 09/28/2023] [Indexed: 10/31/2023] Open
Abstract
The hip joint is called as the coxafemoral or femoroacetabular joint, and it is the articulation of the acetabulum of the pelvis and the head of the femur. The most common surgery in adults is total hip arthroplasty (THA). In this technique, biocompatible materials are used to replace sections of the upper femur and acetabulum. A postoperative patient needs physical rehabilitation and it is necessary to focus on strength and functional status. Instability appears to be a complication in both initial and repeat THA. A 56-year-old male met with an accident, and on consulting with an orthopedic surgeon, an X-ray scan was taken and was then advised for total hip replacement, post-surgery, he developed an infection and was again advised for hip replacement. Post-surgery, the patient received physiotherapy. The four elements of the physiotherapy rehabilitation regimen are therapeutic physical activity, transfers, gait training, and education in daily living skills. Following surgery, physiotherapy rehabilitation may be provided at various times, including right away afterward (within the first five days) and during the initial phase of recovery (within the first three months after discharge). Postural stability can be attained by rehabilitation. Thus, a proper physiotherapy rehabilitation program can improve the quality of life.
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Affiliation(s)
- Nandini C Baheti
- Department of Physiotherapy, Ravi Nair Physiotherapy College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Pallavi Harjpal
- Department of Neuro-Physiotherapy, Ravi Nair Physiotherapy College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
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Management of Traumatic Femur Fractures: A Focus on the Time to Intramedullary Nailing and Clinical Outcomes. Diagnostics (Basel) 2023; 13:diagnostics13061147. [PMID: 36980455 PMCID: PMC10047428 DOI: 10.3390/diagnostics13061147] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Revised: 03/09/2023] [Accepted: 03/15/2023] [Indexed: 03/19/2023] Open
Abstract
Background: Femur shaft factures (FSF) are common injuries following high-energy mechanisms mainly involving motor vehicle crashes (MVC). We evaluated the timings of nailing management and analyzed the pattern of fracture union and outcome in a level 1 trauma center. Methods: This was a retrospective observational study of all the admitted trauma patients who sustained femoral fractures between January 2016 and September 2020. Data were analyzed and compared based on time to Intramedullary Nailing (IMN) (<12 h, 12–24 h and >24 h) and outcomes of FSF (union, delayed union and nonunion). Results: A total of 668 eligible patients were included in the study, of which the majority were males (90.9%) with a mean age of 34.5 ± 15.8, and 54% of the injuries were due to MVCs. The chest (35.8%) was the most commonly associated injured body region, followed by the pelvis (25.9%) and spine (25.4%). Most of femur fractures (93.3%) were unilateral, and 84.4% were closed fractures. The complete union of fractures was observed in 76.8% of cases, whereas only 4.2% and 3.3% cases had delayed union and nonunion, respectively, on the clinical follow-up. Patients in the delayed IMN (>24 h) were severely injured, had bilateral femur fracture (p = 0.001) and had higher rate of external fixation, blood transfusion, pulmonary complications and prolonged hospitalization. Non-union proportion was greater in those who had IMN <24 h, whereas a delayed union was greater in IMN done after 24 h (p = 0.5). Those with a nonunion femur fracture were more likely to have bilateral fracture (p = 0.003), frequently had retrograde nailing (p = 0.01), and high-grade femur fracture (AO type C; p = 0.04). Conclusion: This study showed that femur fracture is not uncommon (8.9%), which is manifested with the variety of clinical characteristics, depending on the mechanism, management and outcome in our center. Bilateral fracture, retrograde nailing and AO classification type C were the significant risk factors of non-union in patients with diaphyseal fractures. The timing of IMN has an impact on the fracture union; however, it is not a statistically significant difference. Therefore, the treating physicians should consider the potential risk factors for a better outcome by careful selection of treatment in sub-groups of patients.
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Cherian N, Oladeji L, Ohnoutka C, Touhey D, Sauer M, Schweser KA, Kfuri M, Cook JL, Rocca GJD, Crist BD. Risk of shortening in operatively treated proximal femur fractures with cephalomedullary nails with dynamically versus statistically locked helical blades. Injury 2023; 54:669-676. [PMID: 36539309 DOI: 10.1016/j.injury.2022.12.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Revised: 11/28/2022] [Accepted: 12/07/2022] [Indexed: 12/13/2022]
Abstract
INTRODUCTION Cephalomedullary nails (CMN) have proven to be effective for the fixation of unstable pertrochanteric hip fractures, but limited data exists regarding the degree of shortening that occurs with nailing systems that offer "dynamically" versus "statistically" locked helical blades. This study aimed to determine the incidence, timing, and amount of postoperative fracture shortening in patients with pertrochanteric hip fractures treated with "dynamically" versus "statistically" locked helical blades. METHODS A retrospective review was performed on patients requiring operative fixation of pertrochanteric fractures. Inclusion criteria were patients aged 55 or older, low energy mechanism of injury, primary surgical open reduction and internal fixation of the injury, surgery performed by a fellowship-trained orthopaedic traumatologist, and radiographic follow up until healing or failure (minimum of 3 months). Quantification of fracture shortening was determined using the lateral screw protuberance method. Fracture shortening measurements were calculated from immediate post-operative films and subsequent radiographs at each follow-up visit. RESULTS 222 patients met inclusion criteria (123 using Depuy Synthes Trochanteric Fixation Nail proximal femoral nailing system (TFN) with static locking; 65 TFN with dynamic locking; 23 using Depuy Synthes Trochanteric Fixation Nail-Advanced proximal nailing system (TFNA) with static locking; and 11 TFNA with dynamic locking). When comparing the final screw protuberance, the TFN dynamic (10.31 mm), TFNA static (9.52 mm), and TFNA dynamic (7.02 mm) groups were found to be significantly less compared to the TFN static cohort (11.67 mm; p < 0.001). The distribution of fracture shortening was found to be significant (p < 0.01). Interval measurements of fracture shortening by repeated measures of ANOVA within groups showed statistically significant increases in screw protuberance for the TFN static (p < 0.001), TFN dynamic (p < 0.001), and TFNA static (p < 0.01) cohorts within the first 60 days postoperatively. The TFNA with dynamic locking group was found to have statistically significant increases until the first 100 days post-operatively (p < 0.02). DISCUSSION The incidence of fracture shortening remains high even with the use of cephalomedullary nails, regardless of dynamization status. Current pertrochanteric fixation constructs continue to favor fracture healing at the direct expense of fracture shortening.
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Affiliation(s)
- Nathan Cherian
- Department of Orthopaedic Surgery, Missouri Orthopaedic Institute, University of Missouri, 1 Hospital Drive, Columbia, MO 65212, United States
| | - Lasun Oladeji
- Department of Orthopaedic Surgery, Missouri Orthopaedic Institute, University of Missouri, 1 Hospital Drive, Columbia, MO 65212, United States
| | - Cole Ohnoutka
- Department of Orthopaedic Surgery, Missouri Orthopaedic Institute, University of Missouri, 1 Hospital Drive, Columbia, MO 65212, United States
| | - Dan Touhey
- Department of Orthopaedic Surgery, Missouri Orthopaedic Institute, University of Missouri, 1 Hospital Drive, Columbia, MO 65212, United States
| | - Madeline Sauer
- Department of Orthopaedic Surgery, Missouri Orthopaedic Institute, University of Missouri, 1 Hospital Drive, Columbia, MO 65212, United States
| | - Kyle A Schweser
- Department of Orthopaedic Surgery, Missouri Orthopaedic Institute, University of Missouri, 1 Hospital Drive, Columbia, MO 65212, United States
| | - Mauricio Kfuri
- Department of Orthopaedic Surgery, Missouri Orthopaedic Institute, University of Missouri, 1 Hospital Drive, Columbia, MO 65212, United States
| | - James L Cook
- Missouri Orthopaedic Institute, University of Missouri, Columbia, MO, United States
| | - Gregory J Della Rocca
- Department of Orthopaedic Surgery, Missouri Orthopaedic Institute, University of Missouri, 1 Hospital Drive, Columbia, MO 65212, United States
| | - Brett D Crist
- Department of Orthopaedic Surgery, Missouri Orthopaedic Institute, University of Missouri, 1 Hospital Drive, Columbia, MO 65212, United States.
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Chokotho L, Wu HH, Shearer D, Lau BC, Mkandawire N, Gjertsen JE, Hallan G, Young S. Outcome at 1 year in patients with femoral shaft fractures treated with intramedullary nailing or skeletal traction in a low-income country: a prospective observational study of 187 patients in Malawi. Acta Orthop 2020; 91:724-731. [PMID: 32698707 PMCID: PMC8023961 DOI: 10.1080/17453674.2020.1794430] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
Background and purpose - Intramedullary nailing (IMN) is underutilized in low-income countries (LICs) where skeletal traction (ST) remains the standard of care for femoral shaft fractures. This prospective study compared patient-reported quality of life and functional status after femoral shaft fractures treated with IMN or ST in Malawi. Patients and methods - Adult patients with femoral shaft fractures managed by IMN or ST were enrolled prospectively from 6 hospitals. Quality of life and functional status were assessed using EQ-5D-3L, and the Short Musculoskeletal Function Assessment (SMFA) respectively. Patients were followed up at 6 weeks, 3, 6, and 12 months post-injury. Results - Of 248 patients enrolled (85 IMN, 163 ST), 187 (75%) completed 1-year follow-up (55 IMN, 132 ST). 1 of 55 IMN cases had nonunion compared with 40 of 132 ST cases that failed treatment and converted to IMN (p < 0.001). Quality of life and SMFA Functional Index Scores were better for IMN than ST at 6 weeks, 3 and 6 months, but not at 1 year. At 6 months, 24 of 51 patients in the ST group had returned to work, compared with 26 of 37 in the IMN group (p = 0.02). Interpretation - Treatment with IMN improved early quality of life and function and allowed patients to return to work earlier compared with treatment with ST. Approximately one-third of patients treated with ST failed treatment and were converted to IMN.
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Affiliation(s)
- Linda Chokotho
- Department of Surgery, College of Medicine, University of Malawi
- Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - Hao-Hua Wu
- Institute for Global Orthopedics and Traumatology, Orthopedic Trauma Institute, University of California San Francisco, San Francisco, CA, USA
| | - David Shearer
- Institute for Global Orthopedics and Traumatology, Orthopedic Trauma Institute, University of California San Francisco, San Francisco, CA, USA
| | - Brian C Lau
- Department of Orthopedic Surgery, Duke University Medical Centre, Durham, NC, USA
| | - Nyengo Mkandawire
- Department of Surgery, College of Medicine, University of Malawi
- School of Medicine, Flinders University, Adelaide, Australia
| | - Jan-Erik Gjertsen
- Department of Clinical Medicine, University of Bergen, Bergen, Norway
- Department of Orthopedic Surgery, Haukeland University Hospital, Bergen, Norway
| | - Geir Hallan
- Department of Clinical Medicine, University of Bergen, Bergen, Norway
- Department of Orthopedic Surgery, Haukeland University Hospital, Bergen, Norway
| | - Sven Young
- Department of Orthopedic Surgery, Haukeland University Hospital, Bergen, Norway
- Department of Surgery, Kamuzu Central Hospital, Lilongwe, Malawi
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Wane M, Naqvi WM, Vaidya L, Kumar K. Kinesiophobia in a Patient With Postoperative Midshaft Fracture: A Case Report of Its Impact on Rehabilitation in a 16-Year-Old Girl. Cureus 2020; 12:e11333. [PMID: 33304670 PMCID: PMC7719470 DOI: 10.7759/cureus.11333] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
Kinesiophobia is an irrational and debilitating fear of physical movement and activity resulting from a feeling of vulnerability to painful injury or re-injury. According to the concept of avoidance of fear, pain is interpreted as threatening, which can trigger pain-related fears and anxiety leading to avoidance behavior. Avoidance action involves a process/period characterized by a person stepping back from undertaking daily tasks like exercise, socializing, and work, which increases the intensity of the painful experience. In hospital settings, kinesiophobia needs to be resolved to ensure a positive result in rehabilitation interventions. The femur is the lower extremity's primary weight-bearing bone. Early fracture fixation in the shaft of the femur allows for early mobilization, thereby reducing the risk of hip and knee stiffness as well as quadriceps and hamstring wasting. In this report, we present the case of a 16-year-old girl with an alleged history of fall who was admitted to Acharya Vinobha Bhave Rural Hospital (AVBRH), Datta Meghe Institute of Medical Sciences (DMIMS) Deemed To Be University (DU), Wardha, India, with primary complaints of pain and swelling over the left thigh. She was diagnosed with a left midshaft femur fracture. An open reduction internal fixation (ORIF) femur interlock nailing was performed to stabilize the fracture, and she was referred to physiotherapy after surgery for further management. The comprehensive rehabilitation program was helpful in alleviating the severe kinesiophobia in the patient, and she was able to resume her activities of daily living (ADLs) independently.
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Affiliation(s)
- Madhuri Wane
- Occupational Therapy, Datta Meghe Institute of Medical Sciences, Wardha, IND
| | - Waqar M Naqvi
- Community Physiotherapy, Datta Meghe Institute of Medical Sciences, Wardha, IND
| | - Laukik Vaidya
- Physiotherapy, Datta Meghe Institute of Medical Sciences, Wardha, IND
| | - Kiran Kumar
- Physiotherapy, Datta Meghe Institute of Medical Sciences, Wardha, IND
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Current Evidence: Plate Versus Intramedullary Nail for Fixation of Distal Tibia Fractures in 2016. J Orthop Trauma 2016; 30 Suppl 4:S2-S6. [PMID: 27768625 DOI: 10.1097/bot.0000000000000692] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Displaced distal tibia shaft fractures are effectively treated with standard plates and intramedullary nails. Plate fixation performed with meticulous soft tissue handling results in minimal risks of infection and poor wound healing. Standard plates have high rates of primary union, whereas locking plates may delay union because of increased stiffness. Tibial healing may also be delayed after plating of the fibula, although fibula reduction and fixation may aid accuracy of reduction of the tibia. Malalignment occurs more often with infrapatellar intramedullary nailing versus plates, and early results of suprapatellar nailing appear promising in minimizing intraoperative malalignment. Long-term function after fixation of the distal tibia is good for most, with poor outcomes often associated with baseline social and mental health issues.
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Larsen P, Elsoe R, Graven-Nielsen T, Laessoe U, Rasmussen S. Local and Widespread Hyperalgesia After Isolated Tibial Shaft Fractures Treated with Intramedullary Nailing. PAIN MEDICINE 2015; 17:1174-80. [PMID: 26814252 DOI: 10.1093/pm/pnv016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/05/2015] [Accepted: 09/07/2015] [Indexed: 11/13/2022]
Abstract
OBJECTIVES Knee pain is accepted as a common complication to intramedullary nailing of tibial fractures. However, no studies have systematically studied the pain sequel following tibial fractures. The objective of this study was to assess pain and hyperalgesia from 6 weeks to 12 months postoperatively after intramedullary nailing of tibial shaft fracture. METHODS A total of 39 patients were included in this 12-month follow-up study. After 6 weeks, 3, 6, and 12 months postoperatively the pain intensity was measured on a visual analog scale (VAS) and the pressure pain sensitivity was assessed bilaterally by pain pressure thresholds (PPTs). RESULTS The mean age at the time of fracture was 42.9 years. Twelve months after surgery, the pain intensity for worst pain during the last 24 hours was 1.8 ± 2.7 cm. The PPTs progressively increased from 6 weeks after surgery to 12 months postoperatively for all PPT sites except for the forearm (P < 0.012). Moreover, the PPTs on the leg were generally reduced on the injured side compared with the non-injured side (P < 0.04). CONCLUSIONS This study suggests that localized, distal, and bilateral hyperalgesia are common following an isolated tibial shaft fracture treated with intramedullary nailing, although no widespread (extrasegmental) hyperalgesia was detected. Such observations may be important for developing the most adequate rehabilitation procedure following a tibial fracture.
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Affiliation(s)
- Peter Larsen
- Departments of *Occupational Therapy and Physiotherapy,
| | | | - Thomas Graven-Nielsen
- Center for Neuroplasticity and Pain (CNAP), SMI, Department of Health Science and Technology, Faculty of Medicine, Aalborg University, Denmark
| | - Uffe Laessoe
- Center for Neuroplasticity and Pain (CNAP), SMI, Department of Health Science and Technology, Faculty of Medicine, Aalborg University, Denmark; Physiotherapy Department, University College of Northern Denmark, Aalborg, Denmark, Denmark
| | - Sten Rasmussen
- Orthopaedic Surgery, and Clinical Medicine, Aalborg University, Denmark
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Larsen P, Elsoe R, Graven-Nielsen T, Laessoe U, Rasmussen S. Decreased muscle strength is associated with impaired long-term functional outcome after intramedullary nailing of femoral shaft fracture. Eur J Trauma Emerg Surg 2014; 41:673-81. [PMID: 26038009 DOI: 10.1007/s00068-014-0488-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2014] [Accepted: 12/10/2014] [Indexed: 01/10/2023]
Abstract
PURPOSE To examine the long-term outcome after intramedullary nailing of femoral diaphysial fractures measured as disease-specific patient reported function, walking ability, muscle strength, pain and quality of life (QOL). METHODS Cross-sectional study. Retrospective review and follow-up with clinical examination of 48 patients treated with intramedullary nailing after femoral shaft fracture between 2007 and 2010. The patients underwent a clinical examination and assessment of walking ability, maximal muscle strength during knee flexion and extension and hip abduction. Hip disability and Osteoarthritis Outcome Score (HOOS) and questionnaire evaluating QOL (Eq5D-5L) were completed by patients. RESULTS Fourty-eight patients agreed to participate. Mean time for follow-up was 4.7 years. The mean HOOS scores were 84.9 (Pain), 86.6 (ADL), 85.0 (Symptoms), 72.6 (QOL), and 69.1 (Sport). The mean muscle strength of knee flexion with the injured leg (226.0 N) was significantly lower then knee flexion with the non-injured leg (259.5 N, P < 0.0001). Likewise for knee extension (335.2 vs 406.4 N, P < 0.001) and hip abduction (129.2 vs 156.0 N, P < 0.001). Significant association between HOOS and an increase in the difference in muscle strength were observed as well as between worse HOOS outcome and increasing body mass index. CONCLUSION This study showed that decreased muscle strength for knee flexion, knee extension and hip abduction was associated with worse long-term functional outcome measured with a disease-specific questionnaire (HOOS) after intramedullary nailing of femoral shaft fracture.
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Affiliation(s)
- P Larsen
- Department of Occupational Therapy and Physiotherapy, Aalborg University Hospital, Aalborg University, 18-22 Hobrovej, 9000, Aalborg, Denmark. .,Department of Clinical Medicine, Aalborg University, Aalborg, Denmark.
| | - R Elsoe
- Department of Orthopaedic Surgery, Aalborg University Hospital, Aalborg, Denmark.,Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - T Graven-Nielsen
- Laboratory for Musculoskeletal Pain and Motor Control, Center for Sensory-Motor Interaction (SMI), Department of Health Science and Technology, Faculty of Medicine, Aalborg University, Aalborg, Denmark
| | - U Laessoe
- Laboratory for Musculoskeletal Pain and Motor Control, Center for Sensory-Motor Interaction (SMI), Department of Health Science and Technology, Faculty of Medicine, Aalborg University, Aalborg, Denmark.,Physiotherapy Department, UCN, Aalborg, Denmark
| | - S Rasmussen
- Department of Orthopaedic Surgery, Aalborg University Hospital, Aalborg, Denmark.,Orthopaedic Surgery Research Unit, Research and Innovation Center, Aalborg University Hospital, Aalborg, Denmark.,Department of Clinical Medicine, Aalborg University, Aalborg, Denmark.,Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
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Yildirim AO, Oken OF, Katı YA, Gulcek M, Ucaner A. Factors affecting the closed reduction of diaphyseal fractures of the femur. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2013; 23:945-51. [PMID: 23412234 DOI: 10.1007/s00590-012-1107-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/14/2012] [Accepted: 10/03/2012] [Indexed: 11/24/2022]
Abstract
INTRODUCTION This level II prospective study investigates patient and fracture-related factors likely to affect closed reduction time in the surgical treatment of femur fractures, and the effect these factors have on closed reduction time. PATIENTS AND METHODS Seventy-nine diaphyseal femur fractures of 75 patients were included in the present study. All fractures were treated with indirect closed reduction by manual traction using antegrade nailing and static, locked, reamed intramedullary nails. The three variables considered to influence the duration of closed reduction, that is, the type of fracture, BMI, and the preoperative period (time from injury to surgery), were evaluated either separately or in a combination of two or three of the variables. Their influence on the closed reduction time was analyzed and evaluated. RESULTS In this study according to the outcomes, a preoperative period ≤24 h had a significant effect in shortening the reduction time. The reduction time was not significantly affected by the type of fracture. The reduction time was prolonged in overweight patients, but the difference was not significant. When the three variables BMI, preoperative period, and fracture types were evaluated together, the common effect of these three variables was not significant. CONCLUSION In conclusion, based on these results, we think that closed reduction should certainly be aimed for in femur fractures in which intramedullary nailing is planned. Also, early surgical intervention appears to have a beneficial effect on the success of closed reduction.
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Affiliation(s)
- Ahmet Ozgur Yildirim
- Ankara Numune Training and Research Hospital, First Clinics of Orthopaedics and Traumatology, Ankara, Republic of Turkiye
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Nasr S, Hunt S, Duncan NA. Effect of screw position on bone tissue differentiation within a fixed femoral fracture. ACTA ACUST UNITED AC 2013. [DOI: 10.4236/jbise.2013.612a009] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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