title: Abduction strength following intramedullary nailing of the femur.
abstract: OBJECTIVE
  To assess hip abductor function, strength and complaints following insertion of a femoral intramedullary nail.
  
  
  METHODS
  Retrospective clinical review.
  
  
  METHODS
  Department of Orthopaedics, Adelaide Women's and Children's Hospital, Adelaide. Department of Orthopaedic Surgery and Trauma, Royal Adelaide Hospital, Adelaide, South Australia, Australia.
  
  
  METHODS
  1. 32 of 37 patients who had an intramedullary nail inserted for an isolated femoral shaft fracture at the Royal Adelaide 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 pathology involving the abductor mechanism were excluded. 3. 40 asymptomatic controls.
  
  
  METHODS
  Intramedullary fixation for femoral shaft fractures or as part of closed femoral shortening. All procedures were performed on a traction table via a gluteal splitting approach with reamed nails.
  
  
  METHODS
  Complaints included, pain, stiffness, limp and diminished walking distance. Examination of abductor function and measurement of abductor strength. Radiological assessment at followup.
  
  
  RESULTS
  Complaints included trochanteric pain (40%, 40%), thigh pain (10%, 8%) and limp (13%, 42%) in the femoral fracture and closed femoral shortening groups respectively. There was significant difference in the abduction strength (p < 0.01) and abduction ratio (p < 0.01) between the control and each treatment group. Abductor weakness correlated (r = 0.30) with the incidence of complaints.
  
  
  CONCLUSIONS
  Pain, limp and weakness are common following insertion of a femoral intramedullary nail. Agluteal retracting approach may minimize abductor weakness.
authors.affiliation: Department of Orthopaedic Surgery, Modbury Public Hospital, South Australia, Australia.
authors.forename: G I
authors.initials: GI
authors.lastname: Bain
authors.forename: A C
authors.initials: AC
authors.lastname: Zacest
authors.forename: D C
authors.initials: DC
authors.lastname: Paterson
authors.forename: J
authors.initials: J
authors.lastname: Middleton
authors.forename: A P
authors.initials: AP
authors.lastname: Pohl
mesh_terms: D000328:Adult; D000704:Analysis of Variance; D001858:Bone Nails / Q000009:adverse effects*; D005069:Evaluation Studies as Topic; D005260:Female; D005264:Femoral Fractures / Q000601:surgery*; D005594:Fracture Fixation, Intramedullary / Q000009:adverse effects / Q000295:instrumentation* / Q000379:methods; D017102:Fracture Healing; D006801:Humans; D007870:Leg Length Inequality / Q000601:surgery; D008297:Male; D018908:Muscle Weakness / Q000209:etiology*; D018482:Muscle, Skeletal / Q000503:physiopathology; D010147:Pain Measurement; D010149:Postoperative Pain / Q000209:etiology* / Q000503:physiopathology; D012189:Retrospective Studies; D013718:Tensile Strength