OTA 2006 Posters
Scientific Poster #80 Basic Science
Gluteus Medius Tendon Injury during Reaming Using a Modified Medial Trochanteric
Portal: A Cadaveric Study
Edward A. Perez, MD (n); Amir A. Jahangir, MD (n);
Rakesh Mashru, MD (n); Thomas A. Russell, MD (n);
University of Tennessee, Campbell Clinic, Memphis, Tennessee, USA
Purpose: Intramedullary nailing of the femur for femoral shaft fractures
is a well-established technique. A described entry portal for a trochanteric
nail is a portal that is lateral to the most proximal tip of the greater
trochanter. Studies have demonstrated that this portal results in an average
of 27% damage to the gluteus medius tendon. Furthermore, the tendinous insertion
of the gluteus medius has been referred to as contributing to the formation
of the "rotator cuff" of the hip, and it has been proposed that
lateral pain in the hip after intramedullary nailing of the femur can be
a result of tears in these tendons. We describe a trochanteric portal that
is located at the medial edge of the greater trochanter. The purpose of
this cadaveric study was to evaluate the damage to the gluteus medius tendon
using our modified portal.
Methods: Ten cadaver hips were used in this study. A guide wire was
placed in the modified medial trochanteric portal using the assistance of
C-arm fluoroscopy and a 14-mm reamer was advanced over the wire. After the
reaming was complete, each hip was dissected and the gluteus medius muscle
and tendon were inspected to evaluate the amount of intrasubstance and medial
tendon damage.
Results: Precise localization of the modified medial trochanteric
portal was achieved in nine of ten cadaver hips. Of those nine hips, the
use of the modified medial trochanteric portal did not result in any visible
damage to the tendinous insertion of the gluteus medius or the medial aspect
of the tendon in any of the specimens.
Conclusion/Significance: During the use of a lateral trochanteric
portal, damage to the gluteus medius tendon is highly likely as described
by McConnell and Tornetta et al. With the use of the modified medial trochanteric
portal, there is no damage to the gluteus medius tendon. Although the clinical implications
of this finding are not known with certainty, the use of the modified medial
trochanteric entry portal for antegrade femoral nailing could possibly result
in less postoperative morbidity compared to the traditional more lateral
trochanteric portal because it does not damage the gluteus medius tendon.
If noted, the author indicates something of value received.
The codes are identified as a-research or institutional support; b-miscellaneous
funding; c-royalties; d-stock options; e-consultant or employee; n-no conflicts
disclosed, and *disclosure not available at time of printing.
·
The FDA has not cleared this drug and/or medical device for the use
described in this presentation (i.e., the drug or medical device is being
discussed for an "off label" use). · · FDA
information not available at time of printing.