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Risk of Injury to the Superior Gluteal Nerve When Using a Proximal Incision for Insertion of a Piriformis-Entry Reamed Femoral Intramedullary NailA Cadaveric Study
Jason A. Lowe, MD1; William Min, MD, MS, MBA1; Mark A. Lee, MD2; Philip R. Wolinsky, MD2
1 Department of Orthopaedic Surgery, University of Alabama at Birmingham, 510 20th Street South, FOT 950C, Birmingham, AL 35294. E-mail address for W. Min: william.min@ortho.uab.edu
2 Department of Orthopaedic Surgery, University of California, Davis Medical Center, 4860 Y Street, Suite 3800, Sacramento, CA 95817
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  • Disclosure statement for author(s): PDF

Investigation performed at University of California, Davis Medical Center, Sacramento, California



Disclosure: One or more of the authors received payments or services, either directly or indirectly (i.e., via his or her institution), from a third party in support of an aspect of this work. In addition, one or more of the authors, or his or her institution, has had a financial relationship, in the thirty-six months prior to submission of this work, with an entity in the biomedical arena that could be perceived to influence or have the potential to influence what is written in this work. No author has had any other relationships, or has engaged in any other activities, that could be perceived to influence or have the potential to influence what is written in this work. The complete Disclosures of Potential Conflicts of Interest submitted by authors are always provided with the online version of the article.

Copyright © 2012 by The Journal of Bone and Joint Surgery, Inc.
J Bone Joint Surg Am, 2012 Aug 01;94(15):1416-1419. doi: 10.2106/JBJS.K.00773
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Abstract

Background: 

This cadaveric study evaluated the risk of injury to the superior gluteal nerve when a proximal incision site is used for insertion of an antegrade, reamed femoral intramedullary nail into the piriformis fossa. Based on prior anatomical studies, our hypothesis is that the use of a proximal incision site for intramedullary nail insertion will consistently injure the superior gluteal nerve.

Methods: 

A reamed femoral intramedullary nail was inserted through a piriformis fossa entry site in six pairs of fresh-frozen cadaver femora. The specimens were randomized to two groups: reaming of the femoral canal with or without a protective sleeve. Damage to the superior gluteal nerve was evaluated by means of layered dissection of specimens. Damage to any part(s) of the superior gluteal nerve was recorded, and the distances between the path of the instrumentation and nail and the branches of the superior gluteal nerve were measured.

Results: 

A “spray” nerve pattern of the superior gluteal nerve was present in all twelve specimens. The average distance and standard deviation between the most superior branch of the superior gluteal nerve and the instrumentation and nail path was 17.75 ± 8.58 mm. The average distance between the most inferior branch of the superior gluteal nerve and the instrumentation and nail path was 22.39 ± 10.52 mm. There were no significant differences between the two groups. There were no injuries to any part of the superior gluteal nerve regardless of whether or not a protective sleeve was used.

Conclusions: 

This anatomic study demonstrated that the superior gluteal nerve is not at risk for injury when a proximal incision site is used to place a reamed intramedullary nail into the piriformis fossa.

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    References

    Accreditation Statement
    These activities have been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint sponsorship of the American Academy of Orthopaedic Surgeons and The Journal of Bone and Joint Surgery, Inc. The American Academy of Orthopaedic Surgeons is accredited by the ACCME to provide continuing medical education for physicians.
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