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. 2024 Nov 5;16(11):e73095.
doi: 10.7759/cureus.73095. eCollection 2024 Nov.

The Impact of Lesser Trochanter Displacement on Hip Flexor Strength Recovery in Patients With Trochanteric Fracture

Takato Nishida  1 , Yoshiki Fujikawa  2 , Yuki Nagamune  2
Affiliations

The Impact of Lesser Trochanter Displacement on Hip Flexor Strength Recovery in Patients With Trochanteric Fracture

Takato Nishida et al. Cureus. .

Abstract

Introduction: Trochanteric fractures (TFs) are common in older individuals and are expected to increase with Japan's aging population. These fractures often result in poor long-term outcomes, such as decreased independent walking and reduced hospital discharge rates. A significant aspect of TF involves displacement of the lesser trochanter (LT), which can weaken hip flexor muscles and potentially affect the recovery of activities of daily living (ADLs), including walking. Previous research has shown conflicting results regarding the effect of lesser trochanteric displacement on hip function and walking ability. This study aimed to determine whether displacement of the LT affects the recovery of hip flexor strength and walking ability at discharge in patients with TF.

Methods: This prospective cohort study included 29 patients with TF admitted to a rehabilitation hospital between April 2023 and June 2024. The patients were classified into two groups: the LT displacement and the non-LT (NLT) displacement groups. Muscle strength (hip flexion, abduction, and knee extension) was measured using a handheld dynamometer. Walking ability assessments included gait speed, timed up-and-go test (TUG), 6-minute walk test (6 MWT), and functional ambulation category (FAC). Cognitive function was evaluated using the Hasegawa Dementia Rating Scale-Revised (HDS-R). Statistical analyses included repeated-measures analysis of variance (ANOVA) for muscle strength comparisons over time, with adjustments for violations of sphericity using the Greenhouse-Geisser correction.

Results: There were no significant differences between the LT and NLT groups in terms of demographic characteristics such as age, sex, or cognitive function. Repeated-measures ANOVA revealed a significant difference in hip flexor strength on the injured side between the groups, with the LT group showing persistent weakness until discharge. Significant improvements were noted in hip abduction and knee extension strength on the injured side, although no group differences were observed. Post-hoc analysis indicated significant strength improvements over time, particularly between admission and discharge, for most muscle groups, except for hip flexor strength in the LT group.

Conclusion: Lesser trochanteric displacement in patients with TF resulted in a specific decline in hip flexor strength on the injured side, which persisted until discharge. However, no significant impact on walking ability was observed, likely because of compensatory mechanisms involving other muscles.

Keywords: hip flexion strength; lesser trochanter displacement; repeated measures anova; trochanteric fracture; walking ability.

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Conflict of interest statement

Human subjects: Consent for treatment and open access publication was obtained or waived by all participants in this study. Ethics Committee of Aichi-Pref Saiseikai Rehabilitation Hospital issued approval 2022201. Animal subjects: All authors have confirmed that this study did not involve animal subjects or tissue. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: Takato Nishida is partly supported by a Grant from the Aichi Society for Physical Therapy to promote research and a Grant-in-Aid for Research at Seijoh University. The authors and co-authors declare no conflicts of interest related to this study. . Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work.

Figures

Figure 1
Figure 1. Flowchart of the selection process of the study participants.
LT, lesser trochanter displacement group; NLT, non-lesser trochanter displacement group
See this image and copyright information in PMC

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