Gait analysis in the postoperative assessment of intertrochanteric femur fractures

Proximal femur fractures (PFFs) are an increasing public health concern. Improving gait and mobility after surgical fixation of intertrochanteric femur fractures (IFFs) is the most important target of research efforts. The purpose of this study is to investigate the role of gait analysis in the functional assessment of over-65 patients with stable and unstable IFFs, at a minimum 6-month follow-up. Fourteen patient's over-65 with IFFs (AO/OTA 31-A) treated with intramedullary nailing (EBA-2, Citieffe Srl, Italy) were enrolled. The patients were divided into two groups according to the fracture stable or unstable pattern, according to AO/OTA classification. At follow-up appointments, clinical outcomes [Harris Hip Score (HHS)], Western Ontario and McMaster University (WOMAC) and gait parameters were assessed. Radiographs were analyzed at the time of surgery and at each follow-up visit. At 3-month follow-up, both groups showed a significantly different gait patterns, compared with control subjects. At 6-month follow-up, a significant improvement of both mean HHS score (p=0.43) and mean WOMAC score was observed (p=0.43) within groups. Nonetheless, patients with stable fractures showed a comparable gait pattern, compared with control subjects, while patients with unstable fractures still presented a worse gait pattern, compared with control subjects. Therefore, in presence of an unstable IFF, a more aggressive rehabilitative program is needed. The data provided by postoperative gait analysis, therefore, could be useful to customize the patients' rehabilitative protocol, to quickly improve their walking ability and autonomy, thus reducing the post-operative re-fall risks.