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Greater trochanter displacements after Charnley’s trochanterotomy, during passive hip movements: a real-time 3D cadaveric approach

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Abstract

Non-unions of greater trochanter (GT) fractures or osteotomies are the source of frequent complications. Two muscles are involved in the genesis of such non-unions, the gluteus medius and the gluteus minimus. Literature says that, during hip flexion, their terminal insertions on the faces of the GT generate an anterior translation of the GT responsible for contact loosening and healing defect. The main goal of this paper was to assess this hypothesis into the 3D space and to quantify the 3D displacements (three translations and three rotations) of the GT after trochanterotomy during passive motions of the hip joint (flexion, abduction–adduction, internal and external rotation). Therefore, we used 13 fresh cadaveric hips, on which we registered the GT displacements thanks to a 3D infrared localizer. An ultra low weight dynamic reference based has been developed to track the motion of the GT without any interference. The results have shown rotatory displacements of the GT around the three axes. This produces a posterior and lateral opening of the osteotomy site associated with a posterior rotatory shear of the GT. Above 45° of hip flexion these three rotations combine together to exert shear on the osteotomy site which is harmful to the osteosynthesis material and the consolidation potential and may explain implant loosening.

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Acknowledgments

To Messieurs Da Silva and Deluermoz, efficient, friendly technicians at the Anatomy Laboratory in Tours (France) managed by Professor Velut, to Joël Savéan at the LATIM (INSERM, U650), for the quality of his images and his creative spirit, and to Mr Lepors for his availability at the Anatomy Laboratory in Brest (France).

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Authors and Affiliations

  1. Faculté de Médecine, Laboratoire d’Anatomie, Brest, 29200, France

    Romain Gérard, Romuald Seizeur, Bernard Sénécail & Christian Lefèvre

  2. INSERM, U650 (LATIM), Brest, 29200, France

    Romain Gérard, Eric Stindel, Guillaume Dardenne, Jean-José Jacq & Christian Lefèvre

  3. Service d’Orthopédie-Traumatologie, CHU Brest, Brest, 29200, France

    Romain Gérard, Eric Stindel & Christian Lefèvre

  4. TELECOM Bretagne, Institut TELECOM, Brest, 29200, France

    Guillaume Dardenne

  5. Université de Bretagne Occidentale, Brest, 29200, France

    Romain Gérard, Eric Stindel, Guillaume Dardenne, Jean-José Jacq, Romuald Seizeur, Bernard Sénécail & Christian Lefèvre

  6. Anatomy and Orthopaedic Surgery, Orthopaedic and Traumatology Surgery Department, CHU La Cavale Blanche, Boulevard Tanguy Prigent, 29200, Brest, France

    Romain Gérard

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  1. Romain Gérard
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Correspondence to Romain Gérard.

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Gérard, R., Stindel, E., Dardenne, G. et al. Greater trochanter displacements after Charnley’s trochanterotomy, during passive hip movements: a real-time 3D cadaveric approach. Surg Radiol Anat 31, 605–613 (2009). https://doi.org/10.1007/s00276-009-0489-8

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  • DOI: https://doi.org/10.1007/s00276-009-0489-8

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