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Soft tissue anatomy around the hip and its implications for choice of entry point in antegrade femoral nailing
Author(s) -
Moein C.M. Ansari,
Verhofstad M.H.J.,
Bleys R.L.A.W.,
van der Werken Chr.
Publication year - 2008
Publication title -
clinical anatomy
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.667
H-Index - 71
eISSN - 1098-2353
pISSN - 0897-3806
DOI - 10.1002/ca.20665
Subject(s) - medicine , greater trochanter , intramedullary rod , trochanter , dissection (medical) , soft tissue , surgery , nail (fastener) , lesser trochanter , anatomy , popliteal fossa , circumflex , cadaver , femur , femoral neck , osteoporosis , artery , materials science , metallurgy , endocrinology
Antegrade intramedullary nailing is an accepted method of treatment for femoral shaft fractures. Entrance of the nail through the trochanteric fossa is currently recommended by some surgeons. This approach results in some cases, however, in loss of abduction strength and persistent pain. Nail insertion at the tip of the greater trochanter may be more favorable. In this study the anatomical relationships of the trochanteric fossa and of the tip of the greater trochanter were explored. Dissection was carried out in 10 fresh human cadaver femurs. The risks and safety of the two entry points with respect to the adjacent soft tissues were assessed. Abductor muscles and tendons, branches of the medial circumflex femoral artery and the hip joint capsule were at risk during nail insertion through the trochanteric fossa. These structures were not endangered during insertion through the trochanteric tip. The reported clinical morbidity after nailing through the trochanteric fossa may result from direct soft tissue injury and may be reduced by choosing the route through the greater trochanter. Clin. Anat. 21:568–574, 2008. © 2008 Wiley‐Liss, Inc.