Abstract
Introduction
Trochanteric entry nailing potentially causes damage to the gluteus medius (GM) tendon. The aim of this study is to determine the amount of iatrogenic damage to the tendon during reaming by measuring the thickness and stiffness of the GM muscle in patients with trochanteric fractures who are treated with trochanteric entry nails using gray-scale ultrasound (GSUS) and shear-wave elastography (SWE).
Methods
Thickness and stiffness values of bilateral GM muscles in 40 patients with trochanteric fractures treated with PFN-A were measured using GSUS and SWE at post-operative sixth week or later. Harris Hip Scores and bilateral active hip abduction measurements of the patients were recorded. The data was analyzed using statistical methods to assess the extent and amount of iatrogenic injury that occurred during trochanteric entry.
Results
Mean age of the patients was 70. Thirty-three fractures occurred with low-energy trauma. In the SWE evaluation, there was no statistically significant difference between ipsi- and contralateral GM muscle thickness measurements or ipsi- and contralateral GM muscle stiffness measurements. Also, the difference between the clinical evaluation results of the ipsi- and contralateral hip functions was not statistically significant.
Discussion
In this study, we used the Harris Hip Score and hip abduction range of motion in addition to SWE and GSUS in order to assess the patients’ functional status. There are studies in the literature that report significant injury to the GM tendon with cephalomedullary nailing. The majority of these studies are cadaver studies with only clinically irrelevant or uncertain evidence. In this study, we aimed to evaluate the potential negative effects of the iatrogenic damage to the bone-tendon junction during nailing, by measuring the stiffness (consistency) and atrophy of the GM muscle alongside the functional evaluation.
Conclusion
We have found no statistically significant difference between operated and intact side GM muscles in terms of stiffness, atrophy, and functional evaluation in patients with TFs treated using PFN-A. The results of our study should not be interpreted as trochanteric entry nailing does not cause any damage on the GM tendon.
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Data availability
The datasets generated during and/or analyzed during the current study are not publicly available due to “Law of Personal Data Protection” but are available from the corresponding author on reasonable request.
References
Bucholz RW, Heckman JD, Court-Brown CM (2009) Rockwood and Green’s fractures in adults. Wolters Kluwer Health, Philadelphia, UNITED STATES
Egol KA, Strauss EJ (2009) Perioperative considerations in geriatric patients with hip fracture: what is the evidence? J Orthop Trauma 23(6):386–394. https://doi.org/10.1097/BOT.0b013e3181761502
Standring S (2015) Gray’s anatomy e-book: the anatomical basis of clinical practice. Elsevier, London, UNITED KINGDOM
Ballal MS, Emms N, Thomas G (2008) Proximal femoral nail failures in extracapsular fractures of the hip. J Orthop Surg (Hong Kong) 16(2):146–149. https://doi.org/10.1177/230949900801600203
McConnell T, Tornetta P 3rd, Benson E, Manuel J (2003) Gluteus medius tendon injury during reaming for gamma nail insertion. Clin Orthop Relat Res 407:199–202. https://doi.org/10.1097/00003086-200302000-00028
Perez EA, Jahangir AA, Mashru RP, Russell TA (2007) Is there a gluteus medius tendon injury during reaming through a modified medial trochanteric portal? A cadaver study J Orthop Trauma 21(9):617–620. https://doi.org/10.1097/BOT.0b013e318157bda7
Noda M, Saegusa Y, Takahashi M, Takada Y, Fujita M, Shinohara I (2017) Decreased postoperative gluteus medius muscle cross-sectional area measured by computed tomography scan in patients with intertrochanteric fractures nailing. J Orthop Surg (Hong Kong) 25(3):2309499017727943. https://doi.org/10.1177/2309499017727943
Ozsoy MH, Basarir K, Bayramoglu A, Erdemli B, Tuccar E, Eksioglu MF (2007) Risk of superior gluteal nerve and gluteus medius muscle injury during femoral nail insertion. J Bone Joint Surg Am 89(4):829–834. https://doi.org/10.2106/jbjs.F.00617
Pan S, Liu XH, Feng T, Kang HJ, Tian ZG, Lou CG (2017) Influence of different great trochanteric entry points on the outcome of intertrochanteric fractures: a retrospective cohort study. BMC Musculoskelet Disord 18(1):107. https://doi.org/10.1186/s12891-017-1472-x
Rosskopf AB, Ehrmann C, Buck FM, Gerber C, Flück M, Pfirrmann CW (2016) Quantitative shear-wave US elastography of the supraspinatus muscle: reliability of the method and relation to tendon integrity and muscle quality. Radiology 278(2):465–474. https://doi.org/10.1148/radiol.2015150908
Aubry S, Nueffer JP, Tanter M, Becce F, Vidal C, Michel F (2015) Viscoelasticity in Achilles tendonopathy: quantitative assessment by using real-time shear-wave elastography. Radiology 274(3):821–829. https://doi.org/10.1148/radiol.14140434
Gennisson JL, Deffieux T, Macé E, Montaldo G, Fink M, Tanter M (2010) Viscoelastic and anisotropic mechanical properties of in vivo muscle tissue assessed by supersonic shear imaging. Ultrasound Med Biol 36(5):789–801. https://doi.org/10.1016/j.ultrasmedbio.2010.02.013
Sigrist RMS, Liau J, Kaffas AE, Chammas MC, Willmann JK (2017) Ultrasound elastography: review of techniques and clinical applications. Theranostics 7(5):1303–1329. https://doi.org/10.7150/thno.18650
Harris WH (1969) Traumatic arthritis of the hip after dislocation and acetabular fractures: treatment by mold arthroplasty. An end-result study using a new method of result evaluation. J Bone Joint Surg Am 51 (4):737–755
Botanlioglu H, Kaynak G, Kantarci F, Guven MF, Zengin G, Aydingoz O (2016) Length, thickness, and elasticity of the patellar tendon after closed wedge high tibial osteotomy: a shear wave elastographic study. J Orthop Surg (Hong Kong) 24(2):194–197. https://doi.org/10.1177/1602400215
Payne K, Payne J, Larkin TA (2020) Patellofemoral pain syndrome and pain severity is associated with asymmetry of gluteus medius muscle activation measured via ultrasound. Am J Phys Med Rehabil 99(7):595–601. https://doi.org/10.1097/phm.0000000000001367
Pu JS, Liu L, Wang GL, Fang Y, Yang TF (2009) Results of the proximal femoral nail anti-rotation (PFNA) in elderly Chinese patients. Int Orthop 33(5):1441–1444. https://doi.org/10.1007/s00264-009-0776-3
Gardenbroek TJ, Segers MJ, Simmermacher RK, Hammacher ER (2011) The proximal femur nail antirotation: an identifiable improvement in the treatment of unstable pertrochanteric fractures? J Trauma 71(1):169–174. https://doi.org/10.1097/TA.0b013e3182213c6e
Simmermacher RK, Ljungqvist J, Bail H, Hockertz T, Vochteloo AJ, Ochs U, Werken C (2008) The new proximal femoral nail antirotation (PFNA) in daily practice: results of a multicentre clinical study. Injury 39(8):932–939. https://doi.org/10.1016/j.injury.2008.02.005
Ergişi Y, Kafa N, Tokgöz MA, Demir E, Kanık ZH, Sezgin EA, Ataoğlu MB (2020) Is gluteus medius injured in patients treated with a trochanter tip entry intramedullary nail? Clinical, electrophysiological and functional outcomes. Jt Dis Relat Surg 31(2):312–319. https://doi.org/10.5606/ehc.2020.74801
Guo R, Xiang X, Qiu L (2018) Shear-wave elastography assessment of gluteal muscle contracture: three case reports. Medicine (Baltimore) 97(44):e13071. https://doi.org/10.1097/md.0000000000013071
Lennox CME, McLatchie GR (1993) The soft tissues: trauma and sports injuries. Elsevier Science & Technology, Oxford, UNITED KINGDOM
Fernandes TL, Pedrinelli A, Hernandez AJ (2011) Muscle injury: physiopathology, diagnosis, treatment and clinical presentation. Rev Bras Ortop 46(3):247–255. https://doi.org/10.1016/s2255-4971(15)30190-7
Järvinen TA, Järvinen TL, Kääriäinen M, Aärimaa V, Vaittinen S, Kalimo H, Järvinen M (2007) Muscle injuries: optimising recovery. Best Pract Res Clin Rheumatol 21(2):317–331. https://doi.org/10.1016/j.berh.2006.12.004
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SAÇ: data acquisition and drafting, MÇ: conceptual design, analysis, and interpretation of the data, revision for intellectual data, and final approval, FEU: data acquisition, analysis, and interpretation of the data, and final approval, and CÖ: data acquisition and drafting.
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This study was approved by our institution’s Ethics Committee with the approval number TÜTF-BAEK 2019/284 and was conducted in accordance with the World Medical Association Declaration of Helsinki Standard of 1964, as revised in 1983 and 2000. All patients were informed about the study in detail before providing written informed consent for enrolment.
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Çölbe, S.A., Çiftdemir, M., Ustabaşıoğlu, F.E. et al. Iatrogenic gluteus medius muscle insertion injury while trochanteric entry nailing due to trochanteric fractures: a comparative study in forty patients with gray-scale ultrasound and shear-wave elastography. International Orthopaedics (SICOT) 45, 3253–3261 (2021). https://doi.org/10.1007/s00264-021-05177-0
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DOI: https://doi.org/10.1007/s00264-021-05177-0