Risk of Superior Gluteal Nerve and Gluteus Medius Muscle Injury During Femoral Nail Insertion.
From: Department of Anatomy, Hacettepe University Faculty of Medicine, and the Department of Anatomy, Ankara University Faculty of Medicine, Ankara, Turkey. hakanozsoy@rocketmail.com
The Journal of bone and joint surgery. American volume
- Publish Date: Apr 2007
- ISSN: 0021-9355
- Volume: 89
- Issue: 4
- Pages: 829-34
- Medium: Print
- Language: English
- Citation (JAMA): Ozsoy Mehmet Hakan, Basarir Kerem, Bayramoglu Alp, et al. Risk of Superior Gluteal Nerve and Gluteus Medius Muscle Injury During Femoral Nail Insertion.. Apr 2007;89:829-34
Abstract
BACKGROUND: Abduction weakness and limping is a well-recognized complication of closed antegrade insertion of femoral nails. Iatrogenic 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 degrees of flexion and 15 degrees of adduction (Position 1), 30 degrees of flexion and 30 degrees of adduction (Position 2), and 60 degrees of flexion and 30 degrees 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
Mesh Headings (Keywords): Adult, Bone Nails, Buttocks, Cadaver, Female, Femoral Fractures, Fracture Fixation, Intramedullary, Humans, Intraoperative Complications, Male, Muscle, Skeletal, Peripheral Nerves, Risk Factors
Check for Full Text / PubMed Unique Identifier (PMID): 17403807
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