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Decreased muscle strength is associated with impaired long-term functional outcome after intramedullary nailing of femoral shaft fracture

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European Journal of Trauma and Emergency Surgery Aims and scope Submit manuscript

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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Acknowledgments

The Department of Orthopaedic surgery and the Department of Occupational and Physiotherapy Aalborg University Hospital, Denmark were acknowledged for proving unrestricted grants.

Conflict of interest

Peter Larsen, Rasmus Elsoe, Thomas Gravne-Nielsen, Uffe Laessoe and Sten Rasmussen declare that they have no conflict of interest.

Compliance with ethical requirements

This study was conducted in accordance with the ethical standards of the responsible committee and with the ethical principles of the 1975 Declaration of Helsinki. The Danish Data Protection Agency (J. nr. 2010-41-4354) and the local ethics committee (J.nr. N-20130031) approved the study. All participants gave their informed consent prior to their inclusion in the study.

Author information

Authors and Affiliations

  1. Department of Occupational Therapy and Physiotherapy, Aalborg University Hospital, Aalborg University, 18-22 Hobrovej, 9000, Aalborg, Denmark

    P. Larsen

  2. Department of Orthopaedic Surgery, Aalborg University Hospital, Aalborg, Denmark

    R. Elsoe & S. Rasmussen

  3. 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

    T. Graven-Nielsen & U. Laessoe

  4. Physiotherapy Department, UCN, Aalborg, Denmark

    U. Laessoe

  5. Orthopaedic Surgery Research Unit, Research and Innovation Center, Aalborg University Hospital, Aalborg, Denmark

    S. Rasmussen

  6. Department of Clinical Medicine, Aalborg University, Aalborg, Denmark

    P. Larsen, R. Elsoe & S. Rasmussen

  7. Department of Clinical Medicine, Aarhus University, Aarhus, Denmark

    S. Rasmussen

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  1. P. Larsen
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Correspondence to P. Larsen.

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Larsen, P., Elsoe, R., Graven-Nielsen, T. et al. Decreased muscle strength is associated with impaired long-term functional outcome after intramedullary nailing of femoral shaft fracture. Eur J Trauma Emerg Surg 41, 673–681 (2015). https://doi.org/10.1007/s00068-014-0488-2

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  • DOI: https://doi.org/10.1007/s00068-014-0488-2

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