Postoperative limping following proximal femoral nailing due to superior gluteal nerve injury: A retrospective observational study.

Abstract

Postoperative limping is a common yet under-investigated complication following proximal femoral nailing (PFN). One overlooked etiology is iatrogenic superior gluteal nerve (SGN) injury. This retrospective study determines the incidence of SGN injury in patients with postoperative limping following PFN and evaluate associated risk factors and functional outcomes. A retrospective cohort study was conducted over five years (2017-2022) involving 213 patients who underwent PFN for intertrochanteric and subtrochanteric femoral fractures. Patients presenting with postoperative limping underwent clinically and radiological evaluation. Electromyography (EMG) and MRI were used for definitive diagnosis of SGN injury. Clinical outcomes and functional scores were analysed over a minimum 12-month follow-up. Of the 213 patients, 38 (17.8 %) exhibited significant postoperative limping. Among these, 19 (8.9 %) had confirmed SGN injury based on EMG and/or MRI. Significant associations were noted with lateral approach technique (p < 0.01), improper trochanteric entry (p < 0.05), and extended operative time (p = 0.03). Functional outcomes measured by the Harris Hip Score (HHS) and Trendelenburg test were significantly poorer in SGN-injured patients. Recovery was partial in most cases with persistent weakness in 63.2 % of affected patients at one year. SGN injury is a notable contributor to postoperative limping following PFN. Accurate surgical technique and improved intraoperative awareness can reduce incidence. Early identification and rehabilitation remain crucial to functional recovery.