Evaluation of the Status of Gluteus Medius Muscle Measured by Computed Tomography Scan in Patients with Intertrochanteric Fractures Treated by Intramedullary Nailing: A Short Term Study

Abstract

Abstract Background: Gluteus medius is the steering muscle of the hip joint and is very important for pelvic balance. It is damaged surgically when we do antegrade nailing for an intertrochanteric femur fracture. There is not much study available in literature regarding the status of this muscle in postoperative phase. Aims: The aim of the study is to evaluate the effect of surgical trauma on gluteus medius muscle using cross-sectional area (CSA) and adipose tissue ratio (ATR) in computed tomography (CT) scan after intramedullary nailing in patients with intertrochanteric fractures comparing with the contralateral normal side and assess the postoperative strength of gluteus medius muscle. Subjects and Methods: A total of 31 patients with intertrochanteric fracture femur who were treated by intramedullary nailing underwent CT scan after 3 months of surgery. In CT, CSA and adipose tissue infiltration were measured at different levels. Clinically, muscle strength was assessed with Medical Research Council (MRC) grading and active hip abduction test (AHAT). Results: All 31 patients showed decrease in CSA and increase in adipose tissue infiltration in operated side gluteus medius muscle compared to the normal side. However, there was not much difference in MRC grading and AHAT scoring. Conclusions: Our imaging findings documented decrease in CSA and increase in ATR in gluteus medius muscle postoperatively. However, compared to other studies, this overall decrease is in small dimensions, possibly due to the small diameter of proximal portion of the nail which is evolved for the Asian population. Clinically, there was not much decrease in the strength of the gluteus medius muscle and it has not caused any functional problems.