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Shortening after intertrochanteric hip fracture treatment may cause worse gait parameters
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Results published in the Journal of Orthopaedic Trauma showed intertrochanteric fractures treated with the trochanteric fixation nail using helical blade fixation may yield a high incidence of shortening, which was associated with worse gait parameters at short-term follow-up.
At follow-up appointments, Elizabeth B. Gausden, MD, MPH, and colleagues measured and recorded temporospatial gait parameters among 72 patients with intertrochanteric hip fractures treated with cephalomedullary nailing using the trochanteric fixation nail (DePuy Synthes) with a helical blade. Researchers also analyzed radiographs at the time of surgery and at each follow-up visit and measured radiographic femoral neck shortening. The Harris Hip Score, VAS for pain, SF-36 Physical Component Score and SF-36 Mental Component Score were completed by patients.
Results showed a mean amount of shortening of 4.7 mm, with shortening of more than 8 mm in 20.8% of patients, of 10 mm or more in 9.7% of patients and of more than 20 mm in 2.8% of patients. Researchers found mean shortening of 3 mm in stable OTA/AO 31-A1 fractures compared with a mean shortening of 5.9 mm for unstable patterns. During gait analysis, increased shortening had a significant correlation with decreased cadence, increased double support time, decreased step length and increased single support asymmetry, according to results. Researchers also noted decreased cadence, increased double support time and decreased step length were predicted by the threshold of 8 mm of shortening. The Harris Hip Score, VAS scale, SF-36 Physical Component Score and SF-36 Mental Component Score had no significant association with shortening, results showed.
“Most devices used to stabilize intertrochanteric hip fractures allow for controlled collapse, or shortening, as the fracture heals. Our results indicate that patients who experienced more shortening along the helical blade returned with worse gait patterns,” Gausden told Healio.com/Orthopedics. “As hip fracture patients are living longer and expecting a return to higher function than ever before, more research is needed in assessing gait pattern in such patients. Perhaps alternative fixation strategies that minimize shortening, or collapse, will result in improved outcomes.” – by Casey Tingle
Disclosures: The authors report no relevant financial disclosures.
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