Musculoskeletal Function and Quality of Life in Elderly Patients After a Subtrochanteric Femoral Fracture Treated With a Cephalomedullary Nail

Abstract

OBJECTIVES: To report the musculoskeletal function and health-related quality of life in elderly patients after a subtrochanteric fracture treated with a single lag screw cephalomedullary nail. DESIGN: Prospective cohort study with a minimum 1-year follow-up. SETTING: University hospital. PATIENTS: Fifty-three patients, mean age 82 years (range, 61-94 years), with a subtrochanteric fracture of the femur. INTERVENTION: Fixation with a long Gamma cephalomedullary nail. MAIN OUTCOME MEASUREMENTS: Reoperation rate, musculoskeletal function (Short Musculoskeletal Function Assessment), and health-related quality of life (EuroQol-5D). RESULTS: Six patients (11%) were reoperated on, five as a result of technical failures and one as a result of an ipsilateral fracture of the distal femur. The Short Musculoskeletal Function Assessment Dysfunction Index increased from 18 before the fracture to 46 at 4 months and 43 at 12 months. The corresponding values for the Short Musculoskeletal Function Assessment Bother Index were 10 before the fracture and 43 and 40 at 4 and 12 months (P < 0.001 between follow-ups and before fracture for both indices). The EuroQol-5Dindex score decreased from 0.85 to 0.49 at 4 months and remained at almost the same level at 12 months, 0.52 (P < 0.001 between follow-ups and before fracture). CONCLUSIONS: A subtrochanteric fracture treated with a single lag screw cephalomedullary nail had a substantial negative impact on the patient's musculoskeletal function according to the Short Musculoskeletal Function Assessment as well as on the patient's health-related quality of life. However, the need for revision surgery was comparatively low.