Femoral Neck Shortening After Internal Fixation of a Femoral Neck Fracture

Abstract

This study assesses femoral neck shortening and its effect on gait pattern and muscle strength in patients with femoral neck fractures treated with internal fixation. Seventy-six patients from a multicenter randomized controlled trial participated. Patient characteristics and Short Form 12 and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) scores were collected. Femoral neck shortening, gait parameters, and maximum isometric forces of the hip muscles were measured and differences between the fractured and contralateral leg were calculated. Variables of patients with little or no shortening, moderate shortening, and severe shortening were compared using univariate and multivariate analyses. Median femoral neck shortening was 1.1 cm. Subtle changes in gait pattern, reduced gait velocity, and reduced abductor muscle strength were observed. Age, weight, and Pauwels classification were risk factors for femoral neck shortening. Femoral neck shortening decreased gait velocity and seemed to impair gait symmetry and physical functioning. In conclusion, internal fixation of femoral neck fractures results in permanent physical limitations. The relatively young and healthy patients in our study seem capable of compensating. Attention should be paid to femoral neck shortening and proper correction with a heel lift, as inadequate correction may cause physical complaints and influence outcome.

Internal fixation of fragility fracturesof the femoral neck

“…Femoral neck shortening and varus displacement of the femoral head following internal fixation of femoral neck fractures are commonly found in a clinical setting. Neck shortening has been shown to negatively affect the clinical outcome in healed fractures (Zlowodzki et al 2008, Zielinski et al 2013. Although our study revealed that interlocking of the three screws significantly reduced the deformation of the proximal femur, the new implant was not able to resist the unwanted femoral neck shortening and varus displacement of the femoral head.…”

Effects of a Multicomponent Home-Based Physical Rehabilitation Program on Mobility Recovery After Hip Fracture: A Randomized Controlled Trial

“…Also shortening of limb length and limitations in limb range of motion are more common after fixation than after arthroplasty (Parker et al 2002). Femoral neck shortening after internal fixation induces walking asymmetry, decreased walking velocity and impaired physical functioning, leading to permanent physical limitations (Zielinski et al 2013). The results of a recent randomized controlled trial suggested that physical functioning, activities of daily living and quality of life favored hemiarthroplasty compared to internal fixation in the first two years, but statistically significant differences between the two surgical methods were no longer found six years after the hip fracture (Stoen et al 2014).…”

Diminished abductor muscular strength in patients with valgus-impacted femoral neck fractures treated by internal fixation: Clinical study and biomechanical considerations

“…A recent multicenter study using a questionnaire demonstrated that patients with severe shortening of the femoral neck accompanied a significant reduction in hip abductor strength and postoperative function. 13 In another study of patients undergoing rehabilitation, diminished strength of multiple lower extremity muscles, including hip extensors and abductors, was shown to have a deleterious effect on gait speed and on maintaining upright balance during the stance phase of walking. 16 These two articles clearly demonstrate functional deterioration among postoperative patients with weakened muscles.…”