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

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.

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Evaluation of the clinical efficacy of 3D Printing technology assisted surgery combined with early postoperative comprehensive rehabilitation in the treatment of Senile Intertrochanteric Fractures

Pakistan Journal of Medical Sciences ◽

10.12669/pjms.37.3.3988 ◽

2021 ◽

Vol 37 (3) ◽

Author(s):

Ye Zhao ◽

Yong-hui Liu ◽

Shu-ge Mao ◽

Xin-xin Zhang

Keyword(s):

3D Printing ◽

Fracture Healing ◽

Hip Joint ◽

Weight Bearing ◽

Control Group ◽

Intertrochanteric Fractures ◽

Printing Technology ◽

3D Printing Technology ◽

Comprehensive Rehabilitation ◽

Experimental Group

Objectives: To observe the clinical value of 3D printing technology assisted surgery combined with early postoperative comprehensive rehabilitation in elderly patients with intertrochanteric fractures. Methods: Sixty elderly patients with intertrochanteric fractures of the femur who were treated in our hospital from January 2018 to January 2020 were selected and randomly divided into two groups. In the experimental group, 3D printing technology assisted surgery combined with early postoperative comprehensive rehabilitation was used for treatment. While in the control group, traditional open reduction and dynamic hip screw internal fixation combined with postoperative conventional treatment was utilized. The duration of surgery, intraoperative blood loss, postoperative hospital stay, weight bearing time, fracture healing time and other surgical indicators were recorded respectively, and hip joint function recovery was evaluated prior to and 2 weeks after surgery. All patients were followed up for six months to observe the occurrence of complications within half a year, including deep vein thrombosis, incision infection, avascular necrosis of femoral head, hip joint stiffness, delayed fracture healing, etc. Subsequently, the differences in postoperative complications between the two groups were compared and analyzed. Results: The operation time, blood loss, postoperative hospital stay, weight bearing time and fracture healing time of the experimental group were better than those of the control group, and the difference was statistically significant (p<0.05). After treatment, the hip joint function of the experimental group was significantly improved compared with the control group, with a statistically significant difference(p=0.03). The incidence of operative complications in the experimental group was 10% (3/30) within six months postoperatively, significantly lower than the 33% (10/30) in the control group, with statistical significance (p=0.03). Conclusion: 3D printing with early rehab proved to be effective treatment in our study. Such a combined treatment has the advantages of precise operative reduction, fast postoperative recovery, and certain safety and effectiveness. doi: https://doi.org/10.12669/pjms.37.3.3988 How to cite this:Zhao Y, Liu YH, Mao SG, Zhang XX. Evaluation of the clinical efficacy of 3D Printing technology assisted surgery combined with early postoperative comprehensive rehabilitation in the treatment of Senile Intertrochanteric Fractures. Pak J Med Sci. 2021;37(3):---------. doi: https://doi.org/10.12669/pjms.37.3.3988 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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Abstract 016: Muscular Strength Predicts All-Cause Mortality Independent of MVPA in Women Ages 63-99 Years

Circulation ◽

10.1161/circ.137.suppl_1.016 ◽

2018 ◽

Vol 137 (suppl_1) ◽

Author(s):

Michael J LaMonte ◽

David M Buchner ◽

Cora E Lewis ◽

Eileen Rillamas-Sun ◽

John Bellettiere ◽

...

Keyword(s):

Physical Activity ◽

Standard Deviation ◽

Muscle Strength ◽

Grip Strength ◽

Gait Speed ◽

Muscular Strength ◽

Sedentary Time ◽

Lower Mortality ◽

Race Ethnicity ◽

Lower Mortality Risk

Background: While some studies report muscle strength is associated with mortality, independent of aerobic physical activity (PA), in older people, there are less data in women and lack of studies adjusting the association for objective measures of PA and physical performance. We prospectively examined this association in 5,061 multiethnic (White, 48.2%; Black, 34.0%; Hispanic, 17.9%) women ages 63-99 (mean 78.3) with complete information for analysis in the Objective Physical Activity and Cardiovascular Health Study. Methods: Quartile categories of dominant hand grip strength (<14, 14-18, 18.1-22.5, >22.5 kg) and EPESE categories of time to complete five consecutive unassisted chair stands (>16.6, 16.6-13.7, 13.6-11.2, <11.2 sec) were the muscle strength exposure measures. Primary covariables included age, race-ethnicity, current smoking, BMI, and number of comorbidities. Accelerometer measured moderate-to-vigorous PA (MVPA) and total sedentary time, and gait speed during a self-paced 8 meter walk test were further assessed as confounding factors. Cox regression was used to estimate hazard ratios (HR) and 95% confidence intervals (CI). Results: There were 306 (5.5%) all-cause deaths during a mean 3.3 year follow-up. Adjusting for primary covariables, significant inverse trends in mortality were observed across categories of grip strength, HR (95% CI) = 1.00 (ref), 0.70 (0.53, 0.93), 0.77 (0.56, 1.05), 0.59 (0.41, 0.87), trend p = .007, and chair stands, 1.00, 0.82 (0.62, 1.09), 0.76 (0.55, 1.04), 0.53 (0.36, 0.77), trend p <.001. Further adjustment for MVPA attenuated these associations which remained statistically significant, 1.00, 0.72, 0.81, 0.66, trend p = .032, and 1.00, 0.91, 0.88, 0.65, trend p = .033, respectively. Similarly, adding sedentary time or gait speed to the primary covariables did not eliminate significance of the inverse mortality trends with either muscle strength measure. Adjusting for primary covariables, each 1-standard deviation (6.2 sec) faster chair stand time was associated with 12% lower mortality risk (p = .004), which was attenuated to 8% risk reduction (p = .04) when further controlling for MVPA. Adjusting for primary covariables and MVPA, each 1-standard deviation (6.8 kg) increment in grip strength was associated with 13% lower mortality risk (p = .04), and this inverse association was generally consistent across subgroups defined by age (interaction p = .78), race-ethnicity (p = .19), and BMI (p = .88). Controlling for gait speed opposed to MVPA resulted in consistent findings. Conclusions: Higher muscular strength is associated with lower mortality in older women, independent of device-measured MVPA and sedentary time, and measured gait speed, an indicator of aerobic fitness. If results are confirmed, in addition to guideline recommendations regarding aerobic PA, promoting skeletal muscle strength is an important component of aging well.

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Effect of Teriparatide in Fracture Healing in Lower Limbs- An Interventional Study

JOURNAL FOR CLINICAL AND DIAGNOSTIC RESEARCH ◽

10.7860/jcdr/2021/47761.14673 ◽

2021 ◽

Author(s):

Sanjeev Kumar ◽

Girish Sahni ◽

Harjit K Singh Chawla ◽

Daljinder Singh

Keyword(s):

Functional Outcome ◽

Adverse Reactions ◽

Weight Bearing ◽

Test Group ◽

Control Group ◽

Dash Score ◽

Early Weight Bearing ◽

Group A ◽

Group B ◽

Radiological Union

Introduction: Many of the trauma patients presenting to the orthopaedic departments suffer from lower limb fractures. This often leads to prolonged period of morbidity and absence from work. Fracture healing can be delayed in elderly patients, postmenopausal women and in communited fractures. Teriparatide (TPH) given subcutaneously for 6 to 9 months, in such cases, may promote clinical and radiological union of bone. Aim: To know the effect of TPH in improving clinical and radiological union and also to evaluate early weight bearing, improvement in pain and functional outcome. Materials and Methods: In this prospective interventional study, a total of 125 patients were initially enrolled for the study and then after meeting inclusion criteria total 104 patients were selected for the study. They were allocated into two groups by randomisation by 1:1 method-group A was test group of 52 cases in which subcutaneous injection TPH 20 mcg daily (for six months) was given along with standard dosage of calcium and vitamin D; while in 52 cases in group B (control group) only calcium and vitamin D were given. Injection TPH was started within 10 days of fracture and given for six months. No placebo injection was given in control group. Time to weight bearing, time to clinical and radiological union and pain by Visual Analogue Score (VAS) were noted at regular follow-up at one month, three months, six months and 12 months and were compared in both the groups. Functional outcome by Disabilities of the Arm, Shoulder and Hand (DASH) score was noted as an additional tool, as DASH score questionnaire shows many activities of daily living that require mobility and stability of lower limb too. Adverse reactions were noted and compared within test and control groups. The collected data were analysed using International Business Machines (IBM) Statistical Package for the Social Sciences (SPSS) version 22.0 software and Mann-Whitney U test was used to calculate p-value. Results: Average time period for full weight bearing with or without support for test group A was 11±2.7 weeks and 16±1.8 weeks in control group B (p-0.001). Average time to clinical union in test group was 12±1.9 weeks and in control group 16±2.2 weeks (p-0.001). Average time to radiological union was 13±1.4 weeks in test group while 22±2.2 weeks in control group (p-0.001). Pain score by VAS and functional outcome by DASH were improved in test group (p-0.001). There was no difference in adverse reactions in both the groups (p>0.05). Conclusion: Regular intake of TPH 20 mcg subcutaneous daily for six months can reduce time to clinical and radiological fracture union, promote early weight bearing and provide better pain control. Hence, better functional outcome and prefracture ambulatory status can be achieved with no significant adverse events.

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An outcome analysis of intertrochanteric fracture of femur managed with proximal femoral nail antirotation II

International Journal of Research in Orthopaedics ◽

10.18203/issn.2455-4510.intjresorthop20192687 ◽

2019 ◽

Vol 5 (4) ◽

pp. 699

Author(s):

Hemeshwar Harshwardhan ◽

Shubhanshu Jain ◽

Manish Sharma

Keyword(s):

Blood Loss ◽

Intramedullary Nailing ◽

Operative Time ◽

Weight Bearing ◽

Harris Hip Score ◽

Intertrochanteric Fractures ◽

Time Duration ◽

Early Weight Bearing ◽

Pull Out ◽

The Mean

Background: Intertrochanteric fractures are common osteoporotic fractures in adults above 60 years with high mortality and morbidity. Common techniques for fixation of these fractures are sliding hip screw and plate or intramedullary nailing. Intramedullary nailing has advantage of short incision, less operative time, rapid rehabilition & thus decreased medical complications. PFNA II is newer intramedullary implant developed to obtain better fixation strength in osteoporotic bones. Biomechanical studies has demonstrated that PFNA II blade has a significance of higher cut out resistance than other commonly used screw systems.Methods: Prospective follow up study carried out at J.L.N. Medical College Ajmer from 1 March 2017 to 31st October 2018. 30 patients with unstable intertrochanteric fractures were included and operated on fracture table in supine position with PFNA2. We measured operative time, duration of hospital stay, modified Harris hip score and complications.Results: The mean age of the patients was 70.83 years of age. The mean time in surgery was 38.2 minutes. The mean amount of blood loss in surgery was 110.8 ml. In implant related complications, 2 patients had cut out and 1 patient had pull - out of the implant. Functional results according to modified Harris hip scores was found to be excellent in 8 (30%) patients, good in 12 (40%) patients, fair in 7 (20%) patients and poor in 3 (10%) patients.Conclusions: Elderly patients treated with PFNA2 has good outcome as less operative time, minimal blood loss, early weight bearing, less union time and very few cases of medial penetration and back out of spiral blade.

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Key-free compression hip screw in the treatment of intertrochanteric fractures with early weight-bearing: A clinical study

The Journal of the American Osteopathic Association ◽

10.1515/jom-1983-830511 ◽

1983 ◽

Vol 83 (5) ◽

pp. 81-94

Author(s):

Mitchell E. Antin

Keyword(s):

Clinical Study ◽

Weight Bearing ◽

Intertrochanteric Fractures ◽

Early Weight Bearing ◽

Hip Screw

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Femoroacetabular impingement in sports medicine: a narrative review

Swiss Sports & Exercise Medicine ◽

10.34045/ssem/2015/9 ◽

2015 ◽

Vol 63 (2) ◽

Keyword(s):

Muscle Strength ◽

Femoroacetabular Impingement ◽

Hip Joint ◽

Weight Bearing ◽

Case Series ◽

Hip Pain ◽

Hip Surgery ◽

Hip Muscle ◽

Hip Function ◽

Surgical Treatments

Femoroacetabular impingement (FAI) is a pathomechanical process of the hip, which can occur in every individual but has a higher prevalence in physically active subjects such as athletes. It is mainly due to bony deformities at the proximal femur and/or acetabulum in conjunction with rigorous or supraphysiological hip ranges of motion. FAI may lead to chondrolabral lesions, hip pain and development of early hip osteoarthritis. Symptomatic FAI patients may present functional limitations during daily activities and sports, reduced hip muscle strength as well as hip joint kinematic and kinetic alterations during weight-bearing activities. Hip surgery whether open or arthroscopic is currently the mainstay for the management of symptomatic FAI. It consists of the treatment of FAI-related intra-articular pathologies, such as acetabular labral tears and articular cartilage lesions, and the surgical correction of the underlying bony deformities. Hip surgery demonstrated to reduce hip pain and improve hip function of symptomatic FAI patients in most case series. In addition, relatively high rates of return to sport were reported for FAI athletes after hip surgery. Nevertheless, incomplete recovery of hip muscle strength and hip joint kinematics and kinetics during functional tasks were shown after hip surgery for FAI. Non-surgical treatments aimed at restoring normal hip muscle and physical function have not been considered as a valid alternative to hip surgery for the management of symptomatic FAI so far. Future research should propose standardized physical therapy protocols for the non-surgical management of symptomatic FAI, and investigate their effectiveness in reducing hip pain and improving hip function. In addition, randomized controlled trials should compare surgical with non-surgical treatments for FAI so as to provide knowledge about the optimal conditions and time point for hip surgery.

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PENGARUH LATIHAN HEXAGONAL OBSTACLE TERHADAP PENINGKATAN DAYA LEDAK POWER OTOT TUNGKAI

WAHANA ◽

10.36456/wahana.v69i2.1065 ◽

2017 ◽

Vol 69 (2) ◽

pp. 24-27

Author(s):

Achmad Nuryadi

Keyword(s):

Statistical Analysis ◽

Standard Deviation ◽

Treatment Group ◽

Muscle Strength ◽

Group Analysis ◽

T Test ◽

Control Group ◽

Leg Muscles ◽

Explosive Power ◽

The Mean

Power is the power and speed of muscle contraction is dynamic and explosive and involvesthe expenditure of maximum muscle strength in the fastest time. Explosive power is one componentof physical condition that is needed in sports. This is supported by the opinion of Sukadiyanto(2011: 128) power is the result of times between strength and speed. To that end, the sequence toincrease power is given after the athlete is trained element of strength and speed. According toRiaydi, (2010) explosive power is a person's ability to use maximum capabilities deployed in theshortest time. The obstacle hexagonal jump is done quickly so that the movements performed areexplosive or abrupt so as to have an effect on the increase of explosive muscle limb power. Theresult of statistical analysis showed that the mean for the treatment group was 2.90 while the meanfor the control group was 1.55 this indicated that the mean group of threatment was greater than thecontrol group. While the results of the threatment group analysis is known that the t-test value is11.599 with the standard deviation of 1.119 and for the control group that the t-test value is 9.131with the standard deviation of 0.759, thus there is indeed the effect of obstacle hexagonal exerciseon increasing the muscle explosive power ) leg muscles.

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Cemented hemi-arthroplasty for unstable intertrochanteric fractures in the elderly: a retrospective study

International Journal of Research in Orthopaedics ◽

10.18203/issn.2455-4510.intjresorthop20203978 ◽

2020 ◽

Vol 6 (6) ◽

pp. 1166

Author(s):

Satya R. Patra ◽

Naresh K. Panigrahi ◽

Madini Manoj ◽

Saswat Samant ◽

Hemanta K. Bamidi ◽

...

Keyword(s):

Retrospective Study ◽

Elderly Patients ◽

Weight Bearing ◽

Hip Dislocation ◽

The Elderly ◽

Treatment Method ◽

Harris Hip Score ◽

Intertrochanteric Fractures ◽

Early Weight Bearing ◽

Hemi Arthroplasty

Background: Unstable intertrochanteric fractures belonging to 31A2 and A3 varieties are difficult challenges for orthopaedic surgeons, particularly in the elderly patients. Osteosynthesis by dynamic hip screw or proximal femoral nail are often plagued by complications like screw cut-out, excessive collapse and fixation failures due to osteoporotic bones. Because of these complications, patients are often kept confined to the bed which may increase the risks of pressure sores, venous thrombosis and pulmonary infections. So, it is desirable to mobilize these elderly patients as quickly as possible following surgery. In recent decades, primary hemi-arthroplasty has emerged as a valuable treatment option for mobilizing these patients early.Methods: We present our retrospective study on 27 patients above 60 years of age, who were managed with cemented bipolar hemi-arthroplasty after sustaining unstable intertrochanteric fractures. All the patients were operated through modified Hardinge approach. The fractured fragments were secured by stainless steel wiring, particularly the greater trochanter, wherever necessary.Results: Twenty-three patients (85%) were able to stand up with walkers by third post-operative day and were able to walk by fifth post-operative day. There was one case of hip dislocation; it was reduced under anaesthesia. No other complications were encountered at an average follow-up of 3.1 years. The Harris hip score was ‘good’ or ‘excellent’ in more than 60% patients.Conclusions: Cemented hemi-arthroplasty appears to be a reliable treatment method for unstable intertrochanteric fractures in the elderly and it allows early weight-bearing and rehabilitation in most patients following surgery.

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Do Squat Exercises With Weight Shift During Pregnancy Improve Postural Control?

International Journal of Women s Health and Reproduction Sciences ◽

10.15296/ijwhr.2019.02 ◽

2018 ◽

Vol 7 (1) ◽

pp. 10-16

Author(s):

Kaname Takeda ◽

Hiromi Yoshikata ◽

Masumi Imura

Keyword(s):

Muscle Strength ◽

Postural Control ◽

Pregnant Women ◽

Muscular Strength ◽

Grip Force ◽

Intervention Group ◽

Control Group ◽

Exercise Habits ◽

Weight Shift ◽

Rectangular Area

Objectives: The present study aimed to investigate the effect of squat exercises with weight shift on muscle strength and postural control during pregnancy. Materials and Methods: The squat group comprised 21 pregnant women in their 20s and 30s with no exercise habits while the control group consisted of 20 randomly selected pregnant women in their 20s and 30s with no exercise habits. The squat group was instructed to perform two sets of daily squat exercises with weight shift in the anterior, posterior, right, and left directions, with 10 repetitions counted as one set, for 10 weeks. The stabilometer was used to measure postural control ability in the second and third trimesters. Meanwhile, muscular strength was taken as the toe grip force and quadriceps muscle strength before and after the intervention. Results: In the squat group, significant increases were observed in the index of postural stability and the stability area. Conversely, however, significant decreases were detected in the average rectangular area. In addition, in the intervention group, significant declines were observed in the rectangular area in the posterior, right, and left directions. However, a considerable increase in muscular strength was only seen after the intervention in toe grip force. Conclusions: Based on the results, it was concluded that everyday squat exercises which were performed during pregnancy improved postural control. The improvement of postural control during squat movements was thought to have a greater impact on plantar sensation than on muscle strength. These findings suggest that squat exercises with weight shift may promote fall prevention.

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Functional outcome of intertrochanteric fractures treated with bipolar hemiarthroplasty

International Journal of Research in Orthopaedics ◽

10.18203/issn.2455-4510.intjresorthop20164392 ◽

2016 ◽

Vol 3 (1) ◽

pp. 1

Author(s):

Rahul Kadam ◽

Ritesh Sawant ◽

Abhay Chhallani

Keyword(s):

Elderly Patients ◽

Functional Outcome ◽

Weight Bearing ◽

Treatment Modalities ◽

Bipolar Hemiarthroplasty ◽

Intertrochanteric Fractures ◽

Early Weight Bearing ◽

Non Union ◽

Cemented Bipolar Hemiarthroplasty ◽

Metal Failure

Background: Comminuted intertrochanteric fractures with severe displacement are common in elderly patients. These patients have poor bone quality and conventional osteosynthetic procedures frequently lead to non-union and metal failure. The primary goals of treatment are stable fixation and early rehabilitation. There are a many treatment for intertrochanteric fractures but our study is on unstable intertrochanteric fractures which are challenging for a surgeon. The aim of this study was to evaluate the results of cemented bipolar hemiarthroplasty as an alternative to other treatment modalities such as DHS or PFN. 21 elderly patients with comminuted and unstable intertrochanteric fractures underwent cemented bipolar hemiarthroplasty.Methods: This study includes 22 cases of intratrochantric fracture. Mean age of patients was 73.3 (range 60 - 91). All patients are treated with bipolar hemiarthoplasty. Patients are followed up for a mean period of 6 months (range 3-9 months).Results: These patients were evaluated using the Harris hip scoring system. 21 out of 22 had excellent to fair outcomes. Conclusions: In our study of 22 patients, 21 had excellent to fair outcomes with primary cemented bipolar hemiarthroplasty. Bipolar hemiarthoplasty offers good functional outcome and early weight bearing and mobilization.

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