Hip Fracture in the Sportive Adult: Case Report of Complete Functional Recovery After Removal of Hardware

Abstract

Context : Pertrochanteric hip fractures in sportive young adults are mainly caused by a high-energy trauma and treated in the same way as in the older population, using an osteosynthesis immediately followed by a rehabilitation program for several months. The current standard is not to remove osteosynthesis material, similar to the case of older patients. Case Presentation : A 45-year-old male cyclist experienced a right pertrochanteric femoral fracture, treated with cephalomedullary nails. After 9 months of adequate rehabilitation, weakness of the quadriceps musculature and functional complaints persisted, objecti fi ed through an isokinetic strength test and a signi fi cantly reduced score on the Hip Disability and Osteoarthritis Outcome Score questionnaire. The patient was unable to return to his previous level of cycling performance. Management and Outcome : After exclusion of structural bone complications, nerve injury, and central sensitization, the functional complaints and strength de fi ciency were hypothesized to be related to the osteosynthesis material. Therefore, the hardware was removed 9 months after the fi rst surgery, and the rehabilitation was continued for another 20 weeks. Very soon after the removal of the hardware, the functional complaints disappeared with a remarkable improvement of the Hip Disability and Osteoarthritis Outcome Score. The isokinetic strength test showed complete recovery of muscle strength 20 weeks after osteosynthesis removal, and preinjury cycling performance values were obtained 9 months posthardware removal. Conclusion : Despite an adequate rehabilitation following a hip fracture, sporty young adults may fail to reach their previous level of functioning. Osteosynthesis removal may be indicated in this sportive population to reach complete muscle strength and functional recovery. The management of hip fractures in the sportive young adult and the identi fi cation of patients who may bene fi t from removal of the hardware require more research.