The Journal of Bone and Joint Surgery, Vol 75, Issue 4 508-513, Copyright © 1993 by Journal of Bone and Joint Surgery, Inc
The function of the quadriceps muscle after a fracture of the femur in patients who are less than seventeen years old
WL Hennrikus, JR Kasser, F Rand, MB Millis and KM Richards
Department of Orthopaedic Surgery, Children's Hospital, Boston, Massachusetts 02115.
Thirty-three patients who had been managed for an isolated, closed fracture
of the femoral shaft when they were less than seventeen years old were
examined at an average of thirty-three months (range, eighteen to fifty-six
months) after the injury. Thirteen patients (39 per cent) had a persistent
deficit in the strength of the quadriceps of the fractured limb, as
identified on testing with a Cybex-II isokinetic dynamometer. Six patients
(18 per cent) had a deficit according to the one-leg-hop for distance test,
fourteen (42 per cent) had an average loss of ten millimeters in the
circumference of the thigh, and sixteen (48 per cent) had an average loss
of 10 degrees of flexion of the knee. The etiological factors that were
thought to possibly be responsible for the weakness of the quadriceps were
evaluated. The amount of maximum displacement of the fracture, as seen on
the initial radiographs, was the only factor that was significant for the
prediction of weakness of the quadriceps (p = 0.006) at both test speeds of
the Cybex dynamometer and in all statistical analyses. Despite the
persistent weakness of the quadriceps, none of the patients had a clinical
problem at the latest follow-up examination. A subclinical deficit in the
strength of the quadriceps may be related to damage sustained by the muscle
at the time of the fracture. On the basis of the results of this study, we
do not recommend a change from the traditional methods of treatment, which
involve early application of a spica cast or use of traction followed by
application of a spica cast.
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