Skip to main content
SpringerLink
Log in

Does lesser trochanter implication affect hip flexion strength in proximal femur fracture?

  • Original Article
  • Published:
European Journal of Trauma and Emergency Surgery Aims and scope Submit manuscript

Abstract

Purpose

In pertrochanteric and intertrochanteric femoral fractures, the avulsion of the lesser trochanter by the pull of the iliopsoas muscle is not uncommon. This fragment is not commonly fixed because the avulsion of the lesser is tough to not influence the clinical outcome but up to date there is no evidence to support this statement. The aim of this study is to evaluate if lesser trochanter implication affects psoas muscle strength in proximal femur fracture.

Materials and methods

Patients with a consolidated intertrochanteric or pertrochanteric fracture associated or not with lesser trochanter fracture were enrolled, respectively, in group A and group B. Criteria of inclusion were the achievement of an anatomic reduction with gamma nail and a complete consolidation of the fracture. Criteria of exclusion were a follow-up shorter than 6 months and age over 65 years old at surgery. Patients were retrospectively reviewed for the purpose of this study. Range of motion, modified Harris Hip Score (mHHS), flexion strength with hip in neutral position, at 90° of flexion and in “figure four” position were evaluated on injured and healthy side. On the pre-operative X-rays, the vertical displacement of the lesser trochanter was calculated.

Results

Groups A and B showed no significant difference in age and follow-up. No statistical difference between the two groups was found in range of motion, mean mHHS, hip flexion strength at 90° of hip flexion. Lesser trochanter fracture group showed a significantly reduced strength in flexion with hip in neutral flexion (mean difference between two groups was 18.5 kgf). Lesser trochanter displacement showed a significant correlation with strength at 90° of flexion.

Conclusions

Our results showed that lesser trochanter implication may result in decreased hip flexion strength. Lesser trochanter displacement is directly correlated with flexion strength. Further studies will be necessary to understand if lesser trochanter fixation may be a good solution for those patients.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. Kokoroghiannis C, Aktselis I, Deligeorgis A, Fragkomichalos E, Papadimas D, Pappadas I. Evolving concepts of stability and intramedullary fixation of intertrochanteric fractures—a review. Int J Care Inj. 2012;43:686–93.

    Article  Google Scholar 

  2. Chapman MW. Fractures of the hip and proximal femur. In: Chapman’s orthopaedic surgery. 3rd edition. Lippincott Williams &Wilkins; 2001.

  3. Norcross KN, Pearson JR. Movement of the lesser trochanter in pertrochanteric fracture postgrad. Med J. 1966;42:16–9.

    CAS  Google Scholar 

  4. Ellis P. The essential guide to effect sizes: statistical power, meta-analysis, and the interpretation of research results. Cambridge University Press; 2010. p. 52.

  5. Thorborg K, Petersen J, Magnusson SP, Hölmich P. Clinical assessment of hip strength using a hand-held dynamometer is reliable. Scand J Med Sci Sports. 2010;20(3):493–501.

    Article  CAS  PubMed  Google Scholar 

  6. Byrd JW, Jones KS. Prospective analysis of hip arthroscopy with 2-year follow-up. Arthroscopy. 2000;16:578–87.

    Article  CAS  PubMed  Google Scholar 

  7. Constant CR. Assessment of the shoulder. In: Watson M, editor. Surgical disorders of the shoulder. New York: Churchill Livingstone; 1991. p. 39–45.

    Google Scholar 

  8. Constant CR, Murley AHG. A clinical method of functional assessment of the shoulder. Clin Orthop Relat Res. 1987;214:160–4.

    PubMed  Google Scholar 

  9. Hébert LJ, Maltais DB, Lepage C, Saulnier J, Crête M, Perron M. Isometric muscle strength in youth assessed by hand-held dynamometry: a feasibility, reliability, and validity study. Pediatr Phys Ther. 2011;23(3):289–99.

    Article  PubMed  Google Scholar 

  10. Bloom N, Cornbleet SL2. Hip rotator strength in healthy young adults measured in hip flexion and extension by using a hand-held dynamometer. PM R. 2014. doi:10.1016/j.pmrj.2014.06.002.

  11. Stratford PW, Balsor BE. A comparison of make and break tests using a hand-held dynamometer and the Kin-Com. J Orthop Sports Phys Ther. 1994;19(1):28–32.

    Article  CAS  PubMed  Google Scholar 

  12. Sherrington C, Lord SR. Reliability of simple portable tests of physical performance in older people after hip fracture. Clin Rehabil. 2005;19(5):496–504.

    Article  PubMed  Google Scholar 

  13. Bogduk N, Pearcy M, Hadfield G. Anatomy and biomechanics of psoas major. Clin Biomech. 1992;7:109–19.

    Article  CAS  Google Scholar 

  14. Wamper KE, Sierevelt IN, Poolman RW, Bhandari M, Haverkamp D. The Harris hip score: do ceiling effects limit its usefulness in orthopedics? Acta Orthop. 2010;81(6):703–7.

    Article  PubMed Central  PubMed  Google Scholar 

  15. Aprato A, Jayasekera N, Villar RN. Does the modified Harris hip score reflect patient satisfaction after hip arthroscopy? Am J Sports Med. 2012;40(11):2557–60.

    Article  PubMed  Google Scholar 

  16. Neptune RR, Zajac FE, Kautz SA. Muscle force redistributes segmental power for body progression during walking. Gait Posture. 2004;19(2):194–205.

    Article  CAS  PubMed  Google Scholar 

  17. Neptune RR, Sasaki K, Kautz SA. The effect of walking speed on muscle function and mechanical energetics. Gait Posture. 2008;28(1):135–43.

    Article  PubMed Central  PubMed  Google Scholar 

  18. Yoshio M, Murakami G, Sato T, Sato S, Noriyasu S. The function of the psoas major muscle: passive kinetics and morphological studies using donated cadavers. J Orthop Sci. 2002;7(2):199–207.

    Article  PubMed  Google Scholar 

  19. Van der Krogt MM, Doorenbosch CAM, Harlaar J. Muscle length and lengthening velocity in voluntary crouch gait. Gait Posture. 2007;26:532–8.

    Article  PubMed  Google Scholar 

Download references

Acknowledgments

We acknowledge the important assistance of Claudia Savoca, IT administrator, for technology support.

Conflict of interest

Alessandro Aprato, Roberto Lo Baido, Alessandro Crosio, Renato Matteotti, Elena Grosso and Alessandro Masse’ declare that they have no conflict of interest. The author also specifies neither contracts nor agreements they might have signed with commercial interests supporting any portion of the work.

Compliance with ethical requirements

The study has been approved by the local ethics committee and has, therefore, been performed in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki and its later amendments. All patients gave their informed consent prior to their inclusion in the study.

Author information

Authors and Affiliations

  1. Orthopaedic Department, School of Medicine, San Luigi Hospital of Orbassano, University of Torino, Regione Gonzole 10, 10043, Orbassano, TO, Italy

    A. Aprato

  2. Orthopaedic Department, School of Medicine, University of Torino, Torino, Italy

    R. Lo Baido, A. Crosio, R. Matteotti & A. Massè

  3. Department of Traumatology, “C.T.O.” Hospital of Turin, Turin, Italy

    E. Grosso

Authors
  1. A. Aprato
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. R. Lo Baido
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. A. Crosio
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. R. Matteotti
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. E. Grosso
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. A. Massè
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to A. Aprato.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Aprato, A., Lo Baido, R., Crosio, A. et al. Does lesser trochanter implication affect hip flexion strength in proximal femur fracture?. Eur J Trauma Emerg Surg 41, 523–529 (2015). https://doi.org/10.1007/s00068-014-0476-6

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00068-014-0476-6

Keywords

Search

Navigation