Gait biomechanics after proximal femoral nailing of intertrochanteric fractures
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(Published version)
Date
2022
Authors
Sivakumar, A.
Rickman, M.
Thewlis, D.
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Journal article
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Journal of Orthopaedic Research, 2022; 41(4):862-874
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Arjun Sivakumar, Mark Rickman, Dominic Thewlis
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Abstract
Proximal femur fractures in the elderly are associated with significant loss of independence, mobility, and quality of life. This prospective study aimed to: (1)investigate gait biomechanics in intertrochanteric fracture (ITF) patients (A1 and A2AO/OTA) managed via femoral nailing at 6 weeks and 6 months postoperative and how these compared with similarly aged elderly controls; and (2) investigate whether femoral offset shortening (FOS) and lateral lag screw protrusion (LSP) were associated with changes in gait biomechanics at postoperative time points. Hipradiographs and gait data were collected for 34 patients at 6 weeks and 6 monthspostoperatively. Gait data were also collected from similarly aged controls. FOS andLSP were measured from radiographs. Joint angles, external moments, and powerswere calculated for the hip, knee, and ankle and compared between time points inITF patients and healthy controls using statistical parametric mapping. The relationship between radiographic measures with gait speed, step length, peak hip abduction, and maximum hip abduction moment was assessed using a Pearson correlation. External hip adduction moments and hip power generation improved inthe first 6 months postoperative, but differed significantly from healthy controls during single limb stance. LSP showed a moderate correlation with maximum hip abduction moment at 6 weeks postoperative (r=−0.469,p= 0.048). These results provide new detail on functional outcomes after ITF and potential mechanisms that functional deficiencies may stem from. Lag screw prominence may be an important factor in maintaining functional independence and minimizing the risk of secondary falls after ITF in the elderly.
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Published April 2023
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© 2022 The Authors. Journal of Orthopaedic Research® published by Wiley Periodicals LLC on behalf of Orthopaedic Research Society. This is an open access article under the terms of the Creative Commons Attribution‐NonCommercial License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited and is not used for commercial purposes.