Abductor muscle weakness and the role of targeted physiotherapy in intertrochanteric fractures treated with PFN

Abstract

Introduction: Intertrochanteric hip fractures are common with increasing age.Unstable intertrochanteric fractures are now commonly fixed using PFN, however it cannot engage greater trochanter on its own. Gluteus Medius and gluteus minimus (main abductors) attach to greater trochanter, hence abductor weakness is a likely consequence especially in comminuted fractures. In this study we measured the incidence of post-operative abductor weakness and result of targeted physiotherapy on it. Materials and Methods: 135 patients with unstable intertrochanteric fractures underwent proximal femoral nailing at our hospital. The patients included in this study were more than 18 years of age with unstable fractures classified according to Modified Evans classification type 3, 4 and 5 with the duration of trauma less than 3 weeks. The functional assessment was made using Modified McKay criteria through analysis of abductor muscle strength. All patients underwent a predetermined physiotherapy as per protocol. Result: Immediate post-operative muscle power was Grade 1-(09 pt.), Grade 2 (39 pt.), Grade 3 (43 pt.) and Grade 4 (43 pt.). Most of the patient improved their muscle power grade at 12 weeks with only 09 patients with grade 2 and 23 patients with grade 3 power. At final months follow up only 08 patients had grade 3 power and only 6 patients had grade 4 power while the rest had muscle power grade 5.In our study excellent score was seen in 87 patients (83%), good in 12 patients (12%) and poor only 7 patients (5%) at 6 months, as per Modified Mckay criteria. Conclusion: Abductor weakness and Trendelenburg gait are surprisingly common in patients treated with PFN and this complaint is often overlooked. Correct surgical method and targeted physiotherapy can help alleviate this problem.