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Rectus femoris muscle atrophy and recovery caused by preoperative pretibial traction in femoral shaft fractures-comparison between traction period - 18/08/17

Doi : 10.1016/j.otsr.2017.05.006 
D.-G. Shim, T.-Y. Kwon, K.-B. Lee
 Department of orthopaedic surgery, Chonbuk National University Medical School, research institute of clinical medicine of Chonbuk National University-biomedical research institute of Chonbuk National University hospital, 634-18, Keumam-dong, Jeonju-shi, Chonbuk, South Korea 

Corresponding author.

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Abstract

Background

Skeletal traction is performed to temporarily stabilize fracture sites before surgery in patients with femoral fracture. To date, however, there is no study evaluating the difference in the degree of the recovery, of the muscle strength, as well as muscle atrophy following skeletal traction. The purpose of this study was to compare the degree of recovery of rectus femoris muscle strength after surgery in association with muscle atrophy by analyzing the duration of preoperative tibial traction, age and sex in patients with femoral fracture.

Hypothesis

Rectus femoris muscle atrophy will progress depending on the duration of preoperative tibial traction, age and sex in patients with femoral fracture.

Patients and method

Thirty-one patients who underwent preoperative pretibial skeletal traction and intramedullary nailing were divided into two groups according to the traction period: group A (n=12) with a duration of traction of <7 days (mean: 4.08±1.78 days) and group B (n=19) ≥7 days (mean: 13.63±7.17 days). The degree of muscle atrophy and recovery were compared between the two groups, according to age and gender. The degree of muscle atrophy was measured by the difference in thickness of the rectus femoris between pre- and post-traction using ultrasound. The degree of muscle recovery was evaluated by the Q-setting and heel off time. Clinical outcome was evaluated by the non-union rate and Lysholm score.

Results

The degree of muscle atrophy was 0.99±0.14mm in group A and 2.22±0.11mm in group B (P<0.001). The Q-setting time was 4.83±0.94 days in group A and 6.56±1.38 days in group B (P=0.001). Heel off time was also shorter in group A at 2.58±0.90 days, taking 3.72±1.27 days in group B (P=0.012). The recovery rate in the rectus femoris was significantly higher in group A than in group B (P<0.001). There was no significant difference in non-union rate between group A and B (P=0.672) but the mean Lysholm score at the last follow-up was significantly higher in group A than in group B (P=0.006). However, no significant differences were detected in the mean thickness of the rectus femoris, Q-setting, and heel off time between the different age and gender groups (P<0.05).

Conclusions

The prolonged duration of preoperative skeletal traction indicates not only that the resulting disuse atrophy would progress further but also that the muscle atrophy would be accelerated more rapidly for shorter periods of time, based on a cut-off value of 7 days. In addition, the rate of rectus femoris muscle recovery and clinical outcomes were lower in patients undergoing traction for longer periods of time. This indicates that it would be effective for increasing the rate of the recovery and minimizing the occurrence of post surgical complications if surgeons could perform surgery at the earliest possible opportunity following traction, within seven days after the onset of trauma.

Level of evidence

IV, retrospective cohort study.

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Keywords : Femur, Shaft fracture, Tibial traction, Muscle atrophy


Plan


 This study was performed by the approval of the Institutional Review Board of Chonbuk National University Research Council (IRB-2014-28).


© 2017  Elsevier Masson SAS. Tous droits réservés.
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Vol 103 - N° 5

P. 691-695 - septembre 2017 Retour au numéro
Article précédent Article précédent
  • Long and short intramedullary nails for fixation of intertrochanteric femur fractures (OTA 31-A1, A2 and A3): A systematic review and meta-analysis
  • Y. Zhang, S. Zhang, S. Wang, H. Zhang, W. Zhang, P. Liu, J. Ma, N. Pervaiz, J. Wang
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  • M. Tricot, P.-A. Deleu, C. Detrembleur, T. Leemrijse

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