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. 2017 Mar 31:11:255-262.
doi: 10.2174/1874325001711010255. eCollection 2017.

Comparison of Post-Operative Muscular Strength Between Gamma Nailing and Hemiarthroplasty System in Femoral Intertrochanteric Fractures

Mitsuaki Noda  1 , Yasuhiro Saegusa  1 , Masayasu Takahashi  1 , Chisa Noguchi  1 , Chihiro Yoshikawa  1 , Hiroshi Mikami  2 , Akira Gotouda  2
Affiliations

Comparison of Post-Operative Muscular Strength Between Gamma Nailing and Hemiarthroplasty System in Femoral Intertrochanteric Fractures

Mitsuaki Noda et al. Open Orthop J. .

Abstract

Background: The current study focuses on the comparison of postoperative muscular strength around the hip joint of patients with femoral intertrochanteric fractures treated either by cephalo-medullary (CM) nailing or a new bipolar hip prosthesis (BHP), an especially attached device to secure displaced greater trochanteric fragment.

Methods: Twenty patients treated with CM nailing were age- and sex- matched with a control group of 20 patients treated with BHP. Maximum isometric forces at the bilateral hip joint were measured during the follow up period. Means of 3 measurements were represented.

Results: The mean and standard deviation values (kg) of muscle strength at the non-operative/ operative side in the CM nailing group were as follows: flexion strength 9.5±4.7/8.5±4.9 (P=0.06), extension strength 6.2±3.5/5.5±3.7 (P=0.08), abduction strength at 0 degrees 7.7±3.5/6.2±2.8 (p=0.002), abduction strength at 10 degrees 5.5±2.0/4.2±2.0 (p=0.001). In the BHP group, mean and standard deviation values of muscle strength at the non-operative/ operative side were as follows: flexion strength 6.5±2.8/6.0±3.4 (P=0.08), extension strength 4.4±0.9/4.4±0.6 (P=0.83), abduction strength at 0 degrees 5.1±1.9/5.0±1.6 (p=0.12), and that at 10 degrees 4.7±1.4/4.6±1.3 (p=0.10).

Conclusion: Our results demonstrate that CM nailing may cause a 25-30% decrease in postoperative muscle strength around the hip joint, particularly during hip abduction. With the new BHP, greater trochanter reduction is achieved allowing early weight bearing and maintaining strength in abduction. Surgeons should consider postoperative muscular strength as one of the necessary factors for selection of the appropriate surgical procedure.

Level of evidence: Therapeutic Level III.

Keywords: Bipolar hip prosthesis; Cephalo medullary nailing; Comparative study; Femoral intertrochanteric fracture; Gluteus medius; Muscle strength.

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Figures

Fig. (1)
Fig. (1)
A novel bipolar hip prosthesis (BHP) implant characterized by an attachment to control upper translation forces of the greater trochanter (arrows) and its radiogram (right).
Fig. (2)
Fig. (2)
Bar graph depicting difference of mean muscle strength between the non-operated and operated side of the CM nailing group, in kilogram force (kgf). Only muscle strength during abduction showed statistically difference (P<0.01). Error bars indicate standard deviation.
Fig. (3)
Fig. (3)
Bar graph showing values of abduction muscle strength between the non-operated and operated side in CM nailing patients with femoral neck shortening of 7 mm or less. Decrease in muscle strength values in the operated side during abduction at 0 and 10 degrees were statistically significant even in less displaced group (p<0.05).
Fig. (4)
Fig. (4)
Bar graph representing the difference in mean muscle strength between the non-operated and operated sides of BHP patients. No statistical difference was founded.
See this image and copyright information in PMC

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