ABDUCTION STRENGTH FOLLOWING INTRAMEDULLARY NAILING OF THE FEMUR

Objectives: To assess hip abductor function, strength and complaints f ollowing insertion of a femoral intramedullary nail. Design: Retrospec tive clinical review. Setting: Department of Orthopaedics, Adelaide Wo men's and Children's Hospital, Adelaide. Department of Orthopaedic Sur gery and Trauma, Royal Adelaide Hospital, Adelaide, South Australia, A ustralia. Patients: 1. 32 of 37 patients who had an intramedullary nai l inserted for an isolated femoral shaft fracture at the Royal Adelaid e Hospital between 1987 and 1990. 2, 14 of 18 patients who had closed femoral shortening for leg length discrepancy, at the Adelaide Women's and Children's Hospital between 1985 and 1987. Patients with patholog y involving the abductor mechanism were excluded. 3. 40 asymptomatic c ontrols. Intervention: Intramedullary fixation for femoral shaft fract ures or as part of closed femoral shortening. All procedures were perf ormed on a traction table via a gluteal splitting approach with reamed nails. Main Outcome Measurements: Complaints included pain, stiffness , limp and diminished walking distance. Examination of abductor functi on and measurement of abductor strength. Radiological assessment at fo llowup. Results: Complaints included trochanteric pain (40%, 40%), thi gh pain (10%, 8%) and limp (13%, 42%) in the femoral fracture and clos ed femoral shortening groups respectively. There was significant diffe rence in the abduction strength (p<0.01) and abduction ratio (p<0.01) between the control and each treatment group. Abductor weakness correl ated (r=0.30) with the incidence of complaints. Conclusion: Pain, limp and weakness are common following insertion of a femoral intramedulla ry nail Agluteal retracting approach may minimize abductor weakness.