title: Decreased muscle strength is associated with impaired long-term functional outcome after intramedullary nailing of femoral shaft fracture.
abstract: OBJECTIVE
  To examine the long-term outcome after intramedullary nailing of femoral diaphysial fractures measured as disease-specific patient reported function, walking ability, muscle strength, pain and quality of life (QOL).
  
  
  METHODS
  Cross-sectional study. Retrospective review and follow-up with clinical examination of 48 patients treated with intramedullary nailing after femoral shaft fracture between 2007 and 2010. The patients underwent a clinical examination and assessment of walking ability, maximal muscle strength during knee flexion and extension and hip abduction. Hip disability and Osteoarthritis Outcome Score (HOOS) and questionnaire evaluating QOL (Eq5D-5L) were completed by patients.
  
  
  RESULTS
  Fourty-eight patients agreed to participate. Mean time for follow-up was 4.7 years. The mean HOOS scores were 84.9 (Pain), 86.6 (ADL), 85.0 (Symptoms), 72.6 (QOL), and 69.1 (Sport). The mean muscle strength of knee flexion with the injured leg (226.0 N) was significantly lower then knee flexion with the non-injured leg (259.5 N, P < 0.0001). Likewise for knee extension (335.2 vs 406.4 N, P < 0.001) and hip abduction (129.2 vs 156.0 N, P < 0.001). Significant association between HOOS and an increase in the difference in muscle strength were observed as well as between worse HOOS outcome and increasing body mass index.
  
  
  CONCLUSIONS
  This study showed that decreased muscle strength for knee flexion, knee extension and hip abduction was associated with worse long-term functional outcome measured with a disease-specific questionnaire (HOOS) after intramedullary nailing of femoral shaft fracture.
authors.affiliation: Department of Occupational Therapy and Physiotherapy, Aalborg University Hospital, Aalborg University, 18-22 Hobrovej, 9000, Aalborg, Denmark. peter.larsen@rn.dk.|Department of Clinical Medicine, Aalborg University, Aalborg, Denmark. peter.larsen@rn.dk.
authors.forename: P
authors.initials: P
authors.lastname: Larsen
authors.affiliation: Department of Orthopaedic Surgery, Aalborg University Hospital, Aalborg, Denmark.|Department of Clinical Medicine, Aalborg University, Aalborg, Denmark.
authors.forename: R
authors.initials: R
authors.lastname: Elsoe
authors.affiliation: Laboratory for Musculoskeletal Pain and Motor Control, Center for Sensory-Motor Interaction (SMI), Department of Health Science and Technology, Faculty of Medicine, Aalborg University, Aalborg, Denmark.
authors.forename: T
authors.initials: T
authors.lastname: Graven-Nielsen
authors.affiliation: Laboratory for Musculoskeletal Pain and Motor Control, Center for Sensory-Motor Interaction (SMI), Department of Health Science and Technology, Faculty of Medicine, Aalborg University, Aalborg, Denmark.|Physiotherapy Department, UCN, Aalborg, Denmark.
authors.forename: U
authors.initials: U
authors.lastname: Laessoe
authors.affiliation: Department of Orthopaedic Surgery, Aalborg University Hospital, Aalborg, Denmark.|Orthopaedic Surgery Research Unit, Research and Innovation Center, Aalborg University Hospital, Aalborg, Denmark.|Department of Clinical Medicine, Aalborg University, Aalborg, Denmark.|Department of Clinical Medicine, Aarhus University, Aarhus, Denmark.
authors.forename: S
authors.initials: S
authors.lastname: Rasmussen
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001858:Bone Nails; D003430:Cross-Sectional Studies; D004185:Disability Evaluation; D005260:Female; D005264:Femoral Fractures / Q000503:physiopathology / Q000601:surgery*; D005500:Follow-Up Studies; D005594:Fracture Fixation, Intramedullary / Q000295:instrumentation* / Q000379:methods; D006801:Humans; D008297:Male; D008875:Middle Aged; D053580:Muscle Strength / Q000502:physiology*; D018482:Muscle, Skeletal / Q000502:physiology*; D010149:Postoperative Pain / Q000209:etiology; D010808:Physical Examination; D011788:Quality of Life; D016059:Range of Motion, Articular / Q000502:physiology; D020127:Recovery of Function / Q000502:physiology; D012189:Retrospective Studies; D011795:Surveys and Questionnaires; D016896:Treatment Outcome; D016138:Walking / Q000502:physiology; D055815:Young Adult
keywords: Femoral fracture; Intramedullary nailing; Long-term outcome; QOL