Gluteus medius tendon injury during reaming for gamma nail insertion

The use of intramedullary hip screws such as the Gamma nail has become a popular option for treatment of proximal femur fractures. The manufacturer recommends that the Gamma nail be inserted at the junction of the anterior (1/3) and posterior (2/3) of the tip of the greater trochanter and on the tip in the same region that the gluteus medius inserts. The purpose of the current cadaveric study was to quantify the damage to the gluteus medius tendon secondary to reaming of the greater trochanter necessary for safe Gamma nail insertion. The gluteus medius was identified and its tendinous insertion was measured. A Kirschner wire was placed in the recommended entry point using the assistance of C-arm fluoroscopy and a 17-mm reamer was advanced over the wire. The tendon then was inspected to evaluate the amount of intrasubstance damage. In 27 of 34 specimens, the portal was contained completely within the tendinous insertion of the gluteus medius. The percentage of the tendon insertion disrupted by the reamer ranged from 14.8% to 52.5% with an average of 27%. During appropriate placement of the Gamma nail, damage to the gluteus medius tendon is unavoidable and should be recognized as a potential cause of postoperative morbidity.