Gluteus Medius Tendon Injury During Reaming for Gamma Nail Insertion

McConnell, T. R.; Tornetta, Paul; Benson, Emily; Manuel, Jennifer

doi:10.1097/00003086-200302000-00028

Cited by 75 publications

(43 citation statements)

References 14 publications

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“…Moreover, as previously observed in traumatology concerning placement of the gamma nail, which results in an average 27% damage to the gluteus medius tendon [8], Mardones et al [9] documented in a cadaver study a significantly increased rate of injury to the gluteus medius and gluteus minimus muscles compared with "open" implantation of the femoral stem. Therefore, THA per-formed through a double incision is a technically demanding procedure and it is currently considered as a surgical approach under investigation because of the inability to provide reproducible results.…”

Section: Introductionmentioning

confidence: 57%

Tissue-sparing surgery in total hip arthroplasty: sensible approaches and tested evidence

Regis

Residori

Rossi

et al. 2007

J Orthopaed Traumatol

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Section: Introductionmentioning

confidence: 57%

Tissue-sparing surgery in total hip arthroplasty: sensible approaches and tested evidence

Regis

Residori

Rossi

et al. 2007

J Orthopaed Traumatol

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“…Difficulties in accessing the correct starting point can lead to longer surgical times. Establishing the proper starting point is very important in avoiding complications; iatrogenic fractures, varus malalignment, and soft tissue injury [12][13][14][15][16].…”

Section: Discussionmentioning

confidence: 99%

Closed femoral intramedullary nailing in the lateral decubitus position with the aid of intraoperative skeletal traction

Kim

Choy

Lee

et al. 2011

Eur J Orthop Surg Traumatol

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The closed intramedullary nailing is the treatment of choice for femoral diaphyseal fractures. These procedures typically have been performed on a fracture table with either supine or lateral position. However, the use of a fracture table has a lot of disadvantages compared to a lateral position on radiolucent routine table. We reviewed one hundred and twenty-eight patients with femur fractures between 2005 and 2009, who were treated with closed femoral intramedullary nailing in lateral decubitus position on radiolucent routine table. Indirect reduction was facilitated by the aid of intraoperative skeletal traction. Clinical and radiologic results were evaluated. There were no rotational or length malreductions that required surgical revision. There were no injuries to the perineum or contralateral leg, nerve palsies, or fracture table-related complications. There were three cases of non-union and two cases of interlocking screw loosening. Lateral decubitus position obviates the need for fracture table, making it easier to establish an entry point for an intramedullary device. Closed femoral intramedullary nailing in lateral decubitus position with the aid of intraoperative skeletal traction is safe and an effective technique with a low incidence of complications compared to the use of fracture table.

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“…The soft tissue injury associated with antegrade intramedullary nailing is well recognized [8,15,17,19]. With the high success rates of fracture healing with this procedure, however, the soft tissue injury associated with nail insertion is generally an accepted comorbidity.…”

Section: Discussionmentioning

confidence: 99%

“…Bain and colleagues reported a 40% incidence of persistent trochanteric pain after femoral nailing [1]. McConnell et al [15] reported that after insertion of a cephalomedullary nail into 34 cadaveric hips, as much as 53% of the abductor tendon insertion was disrupted, although a detailed evaluation of tendon insertion anatomy was not performed.…”

Section: Introductionmentioning

confidence: 99%

Anatomy of the Greater Trochanteric ‘Bald Spot’: A Potential Portal for Abductor Sparing Femoral Nailing?

Gardner

Robertson

Boraiah

et al. 2008

Clin Orthop Relat Res

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Soft tissue injury occurs when using a piriformis portal for femoral nailing. Standard trochanteric portals also can injure the gluteus medius and external rotator tendons, which may be a source of hip pain after nailing. On the lateral facet of the greater trochanter, a "bald spot" may exist that is devoid of tendon insertion. This may be a potential portal for intramedullary nail insertion. We defined the dimensions and location of this region. Cadaveric specimens were dissected to expose the tendon insertions on the greater trochanter. A computer navigation system was used with a stylus and bone morphing to determine the tendon insertions and bald spot anatomy. The greater trochanteric bald spot is covered by the subgluteus medius bursa and has no tendon insertions. Its center lies 11 mm distal to the tip of the greater trochanter and 5 mm anterior to the midline. The shape is ellipsoid with a diameter of 21 mm. This region is large enough to accommodate the size of most nailing system reamers without tendon footprint infringement. Use of this modified entry site may reduce soft tissue injury with nailing procedures and minimize subsequent hip pain.

show abstract

Gluteus Medius Tendon Injury During Reaming for Gamma Nail Insertion

Cited by 75 publications

References 14 publications

Tissue-sparing surgery in total hip arthroplasty: sensible approaches and tested evidence

Tissue-sparing surgery in total hip arthroplasty: sensible approaches and tested evidence

Closed femoral intramedullary nailing in the lateral decubitus position with the aid of intraoperative skeletal traction

Anatomy of the Greater Trochanteric ‘Bald Spot’: A Potential Portal for Abductor Sparing Femoral Nailing?

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