Abductor weakness in intertrochantric fractures operated with PFN and its management

Abstract

Introduction: Intertrochanteric hip fractures are common with advancing age. PFN is now increasingly used to fix unstable intertrochantric fractures however it does not fix greater trochanter. Gluteus medius and gluteus minimus attach to greater trochanter, hence abductor weakness is a likely consequence. In this study we measured the incidence of post operative abductor weakness (trendelenberg gait) and result of targeted physiotherapy on it. Materials and Methods: Between September 2014 and august 2016, 45 patients with unstable intertrochanteric fractures underwent proximal femoral nailing in the Department of Orthopaedics Pt. J. N. M Medical College and Dr. B.R.A.M Hospital, Raipur (C.G.). 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 Mckay criteria through analysis of abductor muscle strength. Result: Immediate Postoperative muscle power was Grade 1 (02 pt.), Grade 2 (27 pt.), and Grade 3 (14 pt.). At 6 months follow up only 02 patients had grade 4 power (due to varus malunion) rest all had muscle power Grade 5. In this study we found that only 2 out of 45 patients (4.4%) had initial abductor power grade 1, grade 2 -64.4% and rest had grade 3 muscle power. Only 2 patient (due to varus malunion) had grade 4 power at 6 months follow-up rest all patients regained power grade 5. Conclusion: Abductor weakness and trendelenberg gait are fairly common in patients treated with PFN and this complaint is often overlooked. Abductor muscle power should be properly assessed post-operatively and physiotherapy for abductor weakness is essential for complete rehabilitation of patients. Keywords: Intertrochantric fracture femur, Abductor weakness, Proximal femoral nail.