Muscle strength recovery and its effects on outcome after open reduction and internal fixation of acetabular fractures.

  • Borrelli J
  • Ricci W
  • Anglen J
 et al. 
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Abstract

OBJECTIVE: To determine the relationship between muscle strength recovery
and functional outcome in patients who were treated for an acetabular
fracture via an anterior approach. DESIGN: Case series. SETTING:
University Medical Center. PATIENTS: Fifteen patients with a displaced
acetabular fracture treated via an anterior, ilioinguinal approach
were studied. Hip muscle strength of these patients was then compared
with the muscle strength of a similar group of patients treated via
a Kocher-Langenbeck approach (posterior approach). These patient
groups were then combined and muscle strength recovery was compared
with the functional outcome. MAIN OUTCOME MEASURE: Primary outcome
measures included hip muscle strength, including work (J/min) and
maximum torque (Nm/kg) for abductors/adductors and flexors/extensors.
Clinical outcome was assessed with the Musculoskeletal Function Assessment
(MFA) questionnaire and the results correlated with muscle strength.
Secondary outcome measures included adequacy of fracture reduction,
radiographic grade, severity of heterotopic ossification, and range
of motion of the affected and unaffected hips. RESULTS: At an average
follow-up of 44 months, patients treated via an anterior approach
had an overall muscle strength deficit of 9%. Hip extension strength
was affected to the least extent (6% deficit when compared with
the unaffected hip) whereas abduction, adduction, and flexion strength
was affected to a greater degree. For each measure the affected side
was typically weaker than the unaffected side. The average MFA score
for the anterior approach group was 17 (range, 0 to 47) with most
patients reporting poorest results in those domains assessing activities
of the arms and legs, and those involving life changes and feelings.
When MFA scores were compared with the muscle strength, a relationship
was found between hip extension/flexion work and maximum torque and
hip adduction work and maximum torque and MFA score. For each of
these muscle groups, patients reported worsening function with decreased
muscle strength. Assessment of the most recent radiographs revealed
9 patients with an excellent radiographic grade, 3 patients with
a good grade, 1 patient with a fair grade, and 2 patients with a
poor grade. Hip range of motion was not statistically different when
the affected hip was compared with the unaffected hip, and none of
these variables correlated with outcome. Heterotopic ossification
was found in 8 patients; 4 with grade 1, and 4 with grade 2. CONCLUSIONS:
Standardized muscle strength determination and completion of an MFA
questionnaire provided a thorough evaluation of patients who had
undergone open reduction and internal fixation of a displaced acetabular
fracture. In these patients, hip muscle strength after operative
treatment of a displaced acetabular fracture directly influences
patient outcome. Therefore, in order to maximize the outcome of these
patients, particular attention must be paid to postoperative muscle
strengthening protocols and accurate and validated methods to assess
strength and outcomes.

Author-supplied keywords

  • Acetabulum
  • Bone
  • Internal
  • injuries/surgery; Adolescent; Adult; Aged; Fractu
  • methods; Fracture Healing; Fractures
  • surgery; Hip Joint; Humans; Male; Middle Aged; Mu

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  • PMID: 16825963

Authors

  • Joseph Borrelli

  • William M Ricci

  • Jeffrey O Anglen

  • Ronald Gregush

  • Jack Engsberg

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