TITLE

Risk of Superior Gluteal Nerve and Gluteus Medius Muscle Injury During Femoral Nail Insertion

AUTHOR(S)
Ozsoy, Mehmet Hakan; Basarir, Kerem; Bayramoglu, Alp; Erdemli, Bulent; Tuccar, Eray; Eksioglu, M. Fatih
PUB. DATE
April 2007
SOURCE
Journal of Bone & Joint Surgery, American Volume;Apr2007, Vol. 89-A Issue 4, p829
SOURCE TYPE
Academic Journal
DOC. TYPE
Article
ABSTRACT
Background: Abduction weakness and limping is a well-recognized complication of closed antegrade insertion of femoral nails. latrogenic injuries to the superior gluteal nerve and the gluteus medius muscle are the most likely contributing factors. The purpose of this study of cadavers was to assess the risk of nerve and muscle injury with various lower-limb positions used during nail insertion. Methods: We studied thirteen hips of ten formalin-fixed adult cadavers. With the cadaver in the full lateral position, a 9-mm reamer was introduced in a retrograde fashion from the intercondylar notch and passed through the gluteus medius muscle. The distance between the point of entry of the reamer into the undersurface of this muscle and the inferior main branch of the superior gluteal nerve (the nerve-reamer distance) and the distance between the entry and exit points of the reamer in the gluteus medius muscle (the intramuscle distance) were measured in three different hip positions: 15° of flexion and 15° of adduction (Position 1), 300 of flexion and 30° of adduction (Position 2), and 60° of flexion and 30° of adduction (Position 3). Results: In Position 1, the average nerve-reamer distance was 7 mm and the average intramuscle distance was 24 mm. In three hips the reamer injured the nerve directly, and in two other hips the distance was ≤5 mm. In Position 2, the average nerve-reamer distance was 21 mm and the average intramuscle distance was 18 mm. In Position 3, the average nerve-reamer distance was 33 mm and the average intramuscle distance was 11 mm. None of the reamers in this position came closer than 20 mm to the nerve. Conclusions: The risk of injury to the superior gluteal nerve and the gluteus medius muscle during closed antegrade insertion of a femoral nail is lessened by increasing the amount of hip flexion and adduction. Clinical Relevance: The risk of injury to both the superior gluteal nerve and the gluteus medius muscle is higher with limited degrees of hip flexion and adduction, such as are possible in the supine position on a fracture table, than it is with greater degrees of hip flexion and adduction, which are possible in the lateral position on a fracture table or in the so-called sloppy lateral position on an ordinary table. Therefore, insertion of a femoral nail with the hip in increased flexion and adduction might help to lower the risk of injuries to the superior gluteal nerve and the gluteus medius muscle.
ACCESSION #
24694015

 

Related Articles

  • DIFFERENTIAL DIAGNOSIS OF DEEP GLUTEAL PAIN IN A FEMALE RUNNER WITH PELVIC INVOLVEMENT: A CASE REPORT. Podschun, Laura; Hanney, William J.; Kolber, Morey J.; Garcia, Ashley; Rothschild, Carey E. // International Journal of Sports Physical Therapy;Aug2013, Vol. 8 Issue 4, p462 

    Background: Gluteal injuries, proximal hamstring injuries, and pelvic floor disorders have been reported in the literature among runners. Some suggest that hip, pelvis, and/or groin injuries occur in 3.3% to 11.5% of long distance runners. The purpose of this case report is to describe the...

  • Hip to 3D printing. J. F. // Engineer (00137758);Jun2014, Vol. 296 Issue 7852, p8 

    The article reports that hip surgery undertaken with a 3D-printed titanium implant and bone stem-cell graft has been conducted at Southampton General Hospital in Southampton, Hampshire, England.

  • A note of caution: size mismatch between the reamer rasp and the actual Thompson hemiarthroplasty implant. Kulangara, J.; Hossain, Munier // European Journal of Orthopaedic Surgery & Traumatology;Jul2010, Vol. 20 Issue 5, p407 

    We present two case reports of patients who underwent cemented Thompson’s hemiarthroplasty. Case reports. We emphasise that there is a size mismatch between the hand reamer and the definitive Thompson’s prosthesis. We wish to stress and warn surgeons, especially relatively...

  • Gluteus medius tears: an under-diagnosed pathology. El-Husseiny, Moataz; Patel, Shelain; Rayan, Faizal; Haddad, Fares // British Journal of Hospital Medicine (17508460);Jan2011, Vol. 72 Issue 1, p12 

    The gluteus medius is the main abductor of the hip and is an essential stabilizer of the hip during the stance phase of gait. Discontinuity of the hip abductor mechanism can lead to an antalgic gait, inability to maintain pelvic neutrality and increased energy cost of ambulation (Bunker et al,...

  • Good Start on Using Biochemical Markers to Compare Surgical Trauma in Total Hip Replacement Approaches. Manner, Paul // Journal of Bone & Joint Surgery, American Volume;8/3/2011, Vol. 93-A Issue 15, pe89-1 

    In this article the author discusses aspects of the study "Comparison of Minimally Invasive Direct Anterior Versus Posterior Total Hip Arthroplasty Based on Inflammation and Muscle Damage Markers," by Patrick F. Bergin et al. Topics include the use of biochemical markers, such as muscle injury...

  • Impacted bone allografts and a cemented stem after failure of an uncemented stem: preliminary results. BUTTARO, MARTIN A.; MARCOS, LUCAS; FARFALLI, GERMAN; COMBA, FERNANDO; PICCALUGA, FRANCISCO // Hip International;Jul-Sep2009, Vol. 19 Issue 3, p221 

    We reviewed the results of impaction bone grafting technique and a cemented stem in 27 consecutive patients with a failed uncemented femoral component. At an average follow-up of 55 months (25 to 94) none of the femoral components were removed or revised because of aseptic loosening or deep...

  • Proper implant selection can quiet ceramic hips. Murphy, Stephen B. // Orthopedics Today;Apr2008, Vol. 28 Issue 4, p92 

    The article discusses a study conducted by doctor Stephen B. Murphy and other surgeons to observe the clinical results of their ceramic hip implants over an 11-year period, and revisions of ceramic hips and a 5-year period in relation to the issue of squeaking ceramic hip. Results revealed that...

  • Radiological validation of a fluoroscopic guided technique for femoral implant positioning during hip resurfacing. Chiron, Philippe; Pailhé, Régis; Reina, Nicolas; Ancelin, David; Sharma, Akash; Maubisson, Laurent; Laffosse, Jean-Michel // International Orthopaedics;Mar2013, Vol. 37 Issue 3, p361 

    Purpose: The positioning of the femoral cup in hip resurfacing is essential for the survival of the implant. We described a technique in 2005 to position the femoral cup guided by fluoroscopy independent of the approach performed. The main objectives were to study the positioning of the femoral...

  • 50 godina totalne proteze kuka - omaž prof. sir Džonu ÄŒarnliju. Mikić, Želimir Đ.; Lešić, Aleksandar R. // Acta Chirurgica Iugoslavica;2013, Vol. 60 Issue 1, p9 

    November 2012 marked the 50th anniversary of the first implantation of a successful and long-lived hip endoprosthesis, which was performed by Prof. Sir John Charnley in the "Centre for Hip Surgery" at a small country place in the north-west England. John Charnley (1911-1982) finished medical...

Share

Read the Article

Courtesy of VIRGINIA BEACH PUBLIC LIBRARY AND SYSTEM

Sorry, but this item is not currently available from your library.

Try another library?
Sign out of this library

Other Topics