Gait biomechanics after proximal femoral nailing of intertrochanteric fractures.

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 A2 AO/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. Hip radiographs and gait data were collected for 34 patients at 6 weeks and 6 months postoperatively. Gait data were also collected from similarly aged controls. FOS and LSP were measured from radiographs. Joint angles, external moments, and powers were calculated for the hip, knee, and ankle and compared between time points in ITF 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 in the 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.