LONG-TERM FUNCTIONAL OUTCOMES AND QUALITY OF LIFE IN YOUNG ADULTS WITH INTERNAL FIXATION OF FEMORAL SHAFT FRACTURE: A CROSS-SECTIONAL STUDY

Yıl 2024, Cilt: 35 Sayı: 1, 97 - 103, 20.04.2024

Muhammed Taha Tüfek , Cansu Gevrek Aslan , Ömür Çağlar , Gizem İrem Kınıklı

https://doi.org/10.21653/tjpr.1253751

Öz

Purpose: Although internal fixation surgery of femoral shaft fracture (FSF) has high rates of union, it affects the patient’s functionality and quality of life due to additional health conditions depending on the traumatic nature of these injuries. This cross-sectional study aimed to investigate the long-term functional outcomes and quality of life of young adults who underwent internal fixation of isolated FSF to compare with healthy peers.
Methods: The Harris Hip Score (HHS) and Stair Climb Test (SCT) were used to evaluate the functionality of the participants. The EuroQol 5-Dimension Questionnaire (EQ-5D) was used to assess the quality of life.
Results: Twenty young adult volunteers with internal fixation surgery aged 18-55 years are included in the FSF group (mean age: 39.55±11.92 years; duration after surgery: 28±7.2 months) and 20 healthy peers (mean age: 42.75±8.83 years) as the control group. The HHS and EQ-5D scores were lower (p<0.001) in patients with FSF; however, the SCT test time was longer in patients with FSF compared to healthy controls (p<0.001).
Conclusion: The results of the present study demonstrated that functional outcomes and quality of life in patients with FSF did not improve well enough compared to healthy peers 2 years after internal fixation surgery. We suggest that assessment of patients with FSF in a long-term period is needed, even after fracture union, to have a better outcome.

Anahtar Kelimeler

Fracture, Quality of life, Femoral Fractures, Function

Destekleyen Kurum

There is no supporting organization.

Teşekkür

We would like to thank all patients who actively participated in this study.

FEMUR ŞAFT KIRIĞINA BAĞLI İNTERNAL FİKSASYON CERRAHİSİ GEÇİRMİŞ GENÇ ERİŞKİNLERDE GEÇ DÖNEM FONKSİYONEL SONUÇLAR VE YAŞAM KALİTESİ: KESİTSEL BİR ÇALIŞMA

Öz

Amaç: Femur cisim kırığı (FCK) için yapılan internal fiksasyon cerrahilerinde kaynama oranları yüksek olmakla birlikte, yaralanmaların travmatik yapısı nedeniyle oluşan ek sağlık durumları hastaların fonksiyonelliğini ve yaşam kalitesini olumsuz etkileyebilmektedir. Bu kesitsel çalışmanın amacı, izole FCK’larında internal fiksasyon uygulanan genç erişkinlerin geç dönem fonksiyonel sonuçlarını ve yaşam kalitelerini sağlıklı yaşıtlarıyla karşılaştırmaktır.
Yöntem: Çalışmaya 18-55 yaş arasında olan ve internal tespit cerrahisi geçirmiş 20 genç yetişkin gönüllü (ortalama yaş: 39,55±11,92 yıl; ameliyat sonrası süre: 28±7,2 ay) ve benzer yaş ve cinsiyette 20 sağlıklı birey (ortalama yaş: 42,75±8,83) dahil edildi. Katılımcıların fonksiyonelliğini değerlendirmek için Harris Kalça Skoru ve Merdiven Çıkma Testi kullanıldı. Yaşam kalitesini değerlendirmek için EuroQol Yaşam Kalitesi Ölçeği kullanıldı.
Sonuçlar: Cerrahi geçiren bireylerde, kalça fonksiyonelliği ve yaşam kalitesi puanları, sağlıklılara göre daha düşük bulunurken (p<0.001); merdiven çıkma test süresi, sağlıklı bireylerden daha uzun bulundu (p<0.001).
Tartışma: Bu çalışmanın sonuçları, femur cisim kırığına bağlı internal fiksasyon cerrahisi geçiren bireylerde, 2 yıl sonra bile kalça ile ilişkili fonksiyonel sonuçların ve yaşam kalitesinin sağlıklı akranlarına göre yeterince düzelmediğini performans testlerinde de yetersizlik olduğunu göstermiştir. Cerrahiden sonra uzun dönemde femur cisim kırığına bağlı internal fiksasyon cerrahisi geçiren bireylerde fonksiyonel yetersizliklerin devam etmesi fizyoterapi ve rehabilitasyon uygulamalarının kalçanın fonksiyonel ve yaşam kalitesi ile ilişkili sonuçlarının geliştirilmesi için bireysel ihtiyaçlara göre devam ettirilmesinin gerekli olduğunu düşünüyoruz.

Anahtar Kelimeler

Femur, Yaşam kalitesi, femoral kırıklar, fonksiyon

Kaynakça

• Denisiuk M, Afsari A. Femoral shaft fractures. Treasure Island (FL): StatPearls Publishing; 2023.
• Trompeter A, Newman K. Femoral shaft fractures in adults. Orthopaedics and Trauma, 2013;27(5):322-331.
• de Moraes FB, da Silva LL, Ferreira FV, Ferro AM, da Rocha VL, Teixeira KI. Epidemiological and radiological evaluation of femoral shaft fractures: Study of 200 cases. Rev Bras Ortop. 2015;44(3):199-203.
• Bekos A, Sioutis S, Kostroglou A, Saranteas T, Mavrogenis AF. The history of intramedullary nailing. Int Orthop. 2021;45(5):1355- 61.
• Hussain N, Hussain FN, Sermer C, Kamdar H, Schemitsch EH, Sternheim A et al. Antegrade versus retrograde nailing techniques and trochanteric versus piriformis intramedullary nailing entry points for femoral shaft fractures: a systematic review and meta-analysis. Can J Surg. 2017;60(1):19-29.
• Mansouri-Tehrani MM, Yavari P, Moosayii D, Eslami S, Nourian SMA. Evaluation of femoral malrotation after intramedullary nailing. Int J Burns Trauma. 2021;11(5):418-423.
• Larsen P, Elsoe R, Graven-Nielsen T, Laessoe U, Rasmussen S. Decreased muscle strength is associated with impaired longterm functional outcome after intramedullary nailing of femoral shaft fracture. Eur J Trauma Emerg Surg. 2015;41(6):673-81.
• Ahmed MA, Khalifa AA. Hip Abductor Muscle Weakness after Antegrade Nailing of Femoral Fractures. Int J Ortho Res.2020;12:241-248.
• el Moumni M, Voogd EH, ten Duis HJ, Wendt KW. Long-term functional outcome following intramedullary nailing of femoral shaft fractures. Injury. 2012;43(7):1154-8.
• Ekström W, Németh G, Samnegård E, Dalen N, Tidermark J. Quality of life after a subtrochanteric fracture: a prospective cohort study on 87 elderly patients. Injury. 2009;40(4):371-6.
• Lerner RK, Esterhai JJ, Polomano RC, Cheatle MD, Heppenstall RB. Quality of life assessment of patients with posttraumatic fracture nonunion, chronic refractory osteomyelitis, and lower-extremity amputation. Clin Orthop Relat Res. 1993;(295):28- 36.
• Lee SY, Park SJ, Gim JA, Kang Y, Choi AH, Seo SH, et al. Correlation between Harris hip score and gait analysis through artificial intelligence pose estimation in patients after total hip arthroplasty. Asian J Surg. 2023;S1015-9584(23)00778-9.
• Aprato A, Secco DC, D’Amelio A, Grosso E, Massè A. Nailing femoral shaft fracture with postless distraction technique: a new technique enabled by shape-conforming pad. J Orthop Traumatol. 2021;22(1):14.
• Hersnaes PN, Gromov K, Otte KS, Gebuhr PH, Troelsen A. Harris Hip Score and SF-36 following metal-on-metal total hip arthroplasty and hip resurfacing - a randomized controlled trial with 5-years follow up including 75 patients. BMC Musculoskelet Disord. 2021;22(1):781.
• Çelik D, Can C, Aslan Y, Ceylan HH, Bilsel K, Ozdincler AR. Translation, cross-cultural adaptation, and validation of the Turkish version of the Harris Hip Score. Hip Int. 2014;24(5):473-9.
• Nightingale EJ, Pourkazemi F, Hiller CE. Systematic review of timed stair tests. J Rehabil Res Dev. 2014;51(3):335-50.
• Onodera CMK, Coelho-Júnior HJ, Sampaio RAC, Santos Duarte Lana JF, Teixeira LFM, Uchida MC, et al. The importance of objectively measuring functional tests in complement to self-report assessments in patients with knee osteoarthritis. Gait Posture. 2020;82:33-7.
• Parsons N, Griffin XL, Achten J, Costa ML. Outcome assessment after hip fracture: is EQ-5D the answer? Bone Joint Res. 2014;3(3):69-75.
• Olerud P, Tidermark J, Ponzer S, Ahrengart L, Bergström G. Responsiveness of the EQ-5D in patients with proximal humeral fractures. J Shoulder Elbow Surg. 2011;20(8):1200-6.
• Çetin A, Ozdemir O, Haghari FS, Taşoğlu. The impact of physical therapy programs on pain and quality of life. Turk J Phys Med Rehabil. 2012;58(2).
• Ergul M, Moghadam AN, Bıglarıan A. Effects of static and functional stretching exercises on lower limb spasticity and function in people with multiple sclerosis: a randomized controlled trial. Turk J Physiother Rehabil. 2021;32(3):43-51.
• EQ-5D [Internet]. Available from: https://euroqol.org/eq-5d-instruments/all-eq-5d-versions/.
• Ugezu A, Nze I, Ihegihu C, Chukwuka N, Ndukwu C, Ofiaeli R. Management of femoral shaft fractures in a tertiary centre, south east Nigeria. Afrimedic Journal. 2018;6(1):27-34.
• Sonbol AM, Almulla AA, Hetaimish BM, Taha WS, Mohmmedthani TS, Alfraidi TA, et al. Prevalence of femoral shaft fractures and associated injuries among adults after road traffic accidents in a Saudi Arabian trauma center. JMSR. 2018;2(2):62.
• Sarraj TS, Shah JZ. Distal femoral shaft fractures. Professional Med. J. 2018;25(3):359-63.
• Elmi A, Rohani AR, Tabrizi A, Esmaili SM. Comparison of outcome of femoral shaft fracture fixation with intramedullary nail in elderly patient and patients younger than 60 years old. Arch Bone Jt Surg. 2014;2(2):103-105.
• Loh J, Huang D, Lei J, Yeo W, Wong MK. Early clinical outcomes of short versus long proximal femoral nail anti-rotation (pfna) in the treatment of intertrochanteric fractures. Malays Orthop J. 2021;15(2):115-121.
• Nilsdotter A, Bremander A. Measures of hip function and symptoms: Harris Hip Score (HHS), Hip Disability and Osteoarthritis Outcome Score (HOOS), Oxford Hip Score (OHS), Lequesne Index of Severity for Osteoarthritis of the Hip (LISOH), and American Academy of Orthopedic Surgeons (AAOS) Hip and Knee Questionnaire. Arthritis Care Res. 2011;63:S200-S207.
• Aygun U, Ayık O. Functional results of patients with femoral intertrochanteric fractures who underwent surgery of proximal femoral nail or bipolar hemiarthroplasty – a comparative study. Ann. Med. Res. 2023;30(1)58-64.
• Devarshi R, Shailendra S, Ahmad O, Shah W, Kumar SS, Nath R. Total hip arthroplasty for failed osteosynthesis of proximal femoral fractures: Clinical outcomes from a low- and middle-income country. J. Arthrosc. Jt. Surg. 2022;9(1):22-27.
• Brand A, von Rüden C, Probst C, Wenzel L, Augat P, Perl M. Early biomechanical outcome in patients with acetabular fractures treated using the pararectus approach: a gait and stair climb analysis study. Eur J Trauma Emerg Surg. 2022;48(2):1307- 1316.
• Almeida GPL, Monteiro IO, Dantas RGO, Tavares MLA, Lima POP. Reliability, validity and responsiveness of the Step Up and Down (StUD) test for individuals with symptomatic knee osteoarthritis. Musculoskelet Sci Pract. 2021;56:102454.
• Davis HC, Blue MNM, Hirsch KR, Luc-Harkey BA, Anderson KC, Smith-Ryan AE, et al. Body composition is associated with physical performance in individuals with knee osteoarthritis. J Clin Rheumatol. 2020;26(3):109-14.
• Fernandez M, David Y, Dubrana F, Di Francia R. Use of a trochanteric fixation nail-advanced (TFNA) with cement augmentation for treatment of trochanteric fractures in patients greater than sixty five years of age. Int Orthop. 2022;46(3):645-51.
• Pan Z, Jiang P, Zhao Y, Xue S, Gao P. Ipsilateral distal third femoral shaft fracture and retrograde intramedullary fixation are not absolute contraindications to anterolateral thigh flap harvest: A case report. JPRAS Open. 2021;31:99-104.
• Ramoutar D, Kodumuri P, Rodrigues J, Olewicz S, Moran C, Ollivere B, et al. The epidemiology and functional outcomes of operative fixation of extracapsular proximal femoral fractures (AO 31-A) in young adults. Eur J Orthop Surg Traumatol. 2017;27(2):267-72.