title: Long-term residual musculoskeletal deficits after femoral shaft fractures treated with intramedullary nailing.
abstract: BACKGROUND
  Locked intramedullary (IM) nailing has been recognized as one of the most reliable methods for treatment of femoral shaft fractures. Although IM nails are routinely used in the treatment of these fractures, the long-term effects of retained IM nails are unknown.
  
  
  METHODS
  Seventeen patients with radiographically documented healed fracture of femoral diaphysis after locked IM nailing technique were evaluated at a follow-up of at least 18 months postoperatively. All patients had returned to their preinjury level of function and activity before the study. The bone mineral densities (BMD) of the injured and contralateral femora were measured using dual energy x-ray absorptiometry (DEXA). BMD of symmetrical regions in the femoral neck and medial and lateral femoral cortex of the implanted and contralateral femora were compared. Postinjury muscle function was assessed from measurement of the isometric strength of six separate muscle groups (quadriceps, hamstrings, hip extensors, hip flexors, hip abductors, and hip adductors) in treated and control extremities.
  
  
  RESULTS
  The average BMD of the femoral neck region of instrumented femora was 9% less than in contralateral control. Within the medial cortex, BMD of the control femora was an average of 20% greater than in the implanted side. In the lateral cortex, the difference averaged 13%. The isometric dynamometric data demonstrated a statistically significant reduction in the strength of the quadriceps of the instrumented extremities as compared with the contralateral ones. There was no significant difference in the strength of the hamstrings, hip extensors, hip flexors, abductors, or adductors. In the control extremities, the average torque generated by isometric contraction of the quadriceps was 3.45+/-1.35 times greater than by the hamstrings. Torque in extension/flexion and abduction/adduction was also observed.
  
  
  CONCLUSIONS
  Our data suggest that limbs with long-term retained IM nails experience a significant reduction in the femur BMD and quadriceps muscle strength. These findings may not be simply related to the implant, and further study is warranted to determine the causes of these changes.
authors.affiliation: Department of Orthopedic Surgery, Baylor College of Medicine, Houston, Texas 77030, USA.
authors.forename: W
authors.initials: W
authors.lastname: Kapp
authors.forename: R W
authors.initials: RW
authors.lastname: Lindsey
authors.forename: P C
authors.initials: PC
authors.lastname: Noble
authors.forename: T
authors.initials: T
authors.lastname: Rudersdorf
authors.forename: P
authors.initials: P
authors.lastname: Henry
mesh_terms: D000293:Adolescent; D000328:Adult; D015519:Bone Density; D001858:Bone Nails; D005260:Female; D005264:Femoral Fractures / Q000000981:diagnostic imaging / Q000601:surgery*; D005594:Fracture Fixation, Intramedullary / Q000009:adverse effects*; D017102:Fracture Healing; D006615:Hip; D006801:Humans; D007537:Isometric Contraction; D008137:Longitudinal Studies; D008297:Male; D018482:Muscle, Skeletal / Q000503:physiopathology*; D011859:Radiography