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Background <p>This study compared postoperative hip muscle strength, as well as clinical outcomes, between elderly patients with femoral neck and intertrochanteric fractures.</p> Methods <p>We conducted a retrospective cohort study at a Level-1 trauma center involving patients aged ≥ 60 years who underwent hip internal fixation or hip replacement for femoral neck or intertrochanteric fractures. Postoperative hip flexion and abduction strength, with strength deficits calculated by subtracting the strength of the injured side from the normal side, were collected. The Harris Hip Score (HHS), Barthel Index (BI), de Morton Mobility Index (DEMMI), Functional Reach Test (FRT), 5-time Sit-to-Stand Test (5TSTS), and Timed Up and Go Test (TUG) were also recorded. All outcomes were analyzed at 3 months follow-up or later.</p> Results <p>The 135 eligible patients were analyzed. The femoral neck group (<i>n</i> = 65) had greater hip flexion strength on the injured side compared to the intertrochanteric group (<i>n</i> = 70) (6.27&#xa0;kg vs. 5.47&#xa0;kg, <i>p</i> = 0.026). The femoral neck group had less hip flexion strength deficits (0.59&#xa0;kg, 8.96%) compared to the intertrochanteric group (1.30&#xa0;kg, 17.04%) (<i>p</i> &lt; 0.05). Hip abduction strength on the injured side and the strength deficit were comparable between groups. Clinical outcomes (HHS, DEMMI, FRT, 5TSTS, TUG) also favored femoral neck group (<i>p</i> &lt; 0.05), while BI scores were comparable. After adjusting for age, only the difference in hip flexion strength deficit remained significant (adjusted <i>p</i> = 0.039).</p> Conclusion <p>Femoral neck fractures showed better hip flexion strength, even after age adjustment. However, functional and performance outcomes became comparable after controlling for age. Intertrochanteric fractures may benefit from focused rehabilitation on flexor strengthening, balance training, and prolonged gait aid use to reduce fall risk.</p>

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Hip muscle strength deficits and clinical outcomes differ between elderly patients with femoral neck and intertrochanteric fractures

  • 期刊论文

  • 发表日期：

    2025年12月24日

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  • Napol Ratanasermsub,
  • Chavarin Amarase,
  • Pathit Sirichuchnin,
  • Saran Tantavisut

摘要

Background

This study compared postoperative hip muscle strength, as well as clinical outcomes, between elderly patients with femoral neck and intertrochanteric fractures.

Methods

We conducted a retrospective cohort study at a Level-1 trauma center involving patients aged ≥ 60 years who underwent hip internal fixation or hip replacement for femoral neck or intertrochanteric fractures. Postoperative hip flexion and abduction strength, with strength deficits calculated by subtracting the strength of the injured side from the normal side, were collected. The Harris Hip Score (HHS), Barthel Index (BI), de Morton Mobility Index (DEMMI), Functional Reach Test (FRT), 5-time Sit-to-Stand Test (5TSTS), and Timed Up and Go Test (TUG) were also recorded. All outcomes were analyzed at 3 months follow-up or later.

Results

The 135 eligible patients were analyzed. The femoral neck group (n = 65) had greater hip flexion strength on the injured side compared to the intertrochanteric group (n = 70) (6.27 kg vs. 5.47 kg, p = 0.026). The femoral neck group had less hip flexion strength deficits (0.59 kg, 8.96%) compared to the intertrochanteric group (1.30 kg, 17.04%) (p < 0.05). Hip abduction strength on the injured side and the strength deficit were comparable between groups. Clinical outcomes (HHS, DEMMI, FRT, 5TSTS, TUG) also favored femoral neck group (p < 0.05), while BI scores were comparable. After adjusting for age, only the difference in hip flexion strength deficit remained significant (adjusted p = 0.039).

Conclusion

Femoral neck fractures showed better hip flexion strength, even after age adjustment. However, functional and performance outcomes became comparable after controlling for age. Intertrochanteric fractures may benefit from focused rehabilitation on flexor strengthening, balance training, and prolonged gait aid use to reduce fall risk.