Evaluation of the superior gluteal nerve during proximal femoral nailing

Abstract

AimThe superior gluteal nerve may be compromised during hip surgery. We retrospectively evaluated the patients who underwent proximal femoral nail-ing for unstable trochanteric fractures in order to investigate the presence of superior gluteal nerve injury and its clinical findings.MethodTwenty five patients (14 women, 11 men) were included in the study who had femoral nailing between January 2004 and March 2010 at Hamidiye Sisli Etfal Training and Research Hospital Department of Orthopaedics. Two different types of nails which have similar designs and surgical techniques were used for fracture fixation. Patients who had a history of cerebrovascular disease, electromyography findings of polyneuropathy, or degenerative ver-tebral disease were excluded from the study. Patients were evaluated clini-cally and radiologically. Findings related to acute denervation in the gluteus medius muscle and motor unit action potential changes were accepted as signs of superior gluteal nerve injury.ResultsEight patients were using sup-port during walking and three of these patients had positive Trendelenburg sign, but only one patient had acute denervation signs of the superior gluteal nerve.ConclusionBased on the present study the incidence of iatrogenic nerve injury is a rare complication of proximal femoral nailing. Elderly pa-tients, regardless of whether they have nerve injury, may limp and need to use a walking support.

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