Mobility after proximal femoral fracture: the relevance of leg extensor power, postural sway and other factors.
We studied 40 previously healthy women (median age 83 years 90% central range 77-90) 1 week after surgical fixation of their proximal femoral fracture to establish the significance of leg extensor power, postural sway, age, pre-injury mobility and fracture type in recovery of walking and stair-climbing ability. Subjects demonstrated a range of walking and stair-climbing abilities. Those not mobile all had sway greater than 40.9 cm/1 min and were more likely to have suffered a trochanteric fracture (p < 0.05). These subjects were not the oldest or those with the worst pre-injury mobility, but did report much greater pain (p < 0.05). Multiple linear regression revealed leg extensor power in the fractured leg (LEPf) to be the most important determinant of walking speed (R2 0.40, p < 0.001) and stair climbing time (R2 0.33, p < 0.002). LEPf was less than in the uninjured leg (p < 0.001), and accounted for only 30% of the total power output. LEPf was determined by pain, and not pre-injury mobility or fracture pattern. These findings have implications for the development of rehabilitation programmes.
D000203:Activities of Daily Living / Q000145:classification; D000368:Aged; D000369:Aged, 80 and over; D005080:Exercise Test; D005260:Female; D005500:Follow-Up Studies; D005593:Fracture Fixation, Internal; D015577:Geriatric Assessment; D006620:Hip Fractures / Q000503:physiopathology / Q000601:surgery*; D006801:Humans; D018482:Muscle, Skeletal / Q000503:physiopathology; D011183:Postoperative Complications / Q000503:physiopathology*; D004856:Postural Balance / Q000502:physiology; D011187:Posture / Q000502:physiology*; D016059:Range of Motion, Articular / Q000502:physiology*; D016138:Walking / Q000502:physiology; D016474:Weight-Bearing / Q000502:physiology*