Anterior trochanteric muscle pedicle graft.

We describe an anterior trochanteric muscle pedicle graft based on the gluteus medius and its neurovascu!ar supply. Vascular injection and anatomical dissection were done in four cadavers to study the blood supply of this pedicle graft. The ascending branch of the superior gluteal artery was found to skirt the rim of the iliac crest to supply the gluteus medius and minimus muscles. The descending branch of the superior gluteal artery and the superior gluteal nerve enter the deep surface of the gluteus medius about 4 cm from the tip of the trochanter. Therefore the anterior third of the gluteus medius along with the anterior third of the greater trochanter can be safely mobilised as a pedicle up to this point without damaging the neurovascular supply. This technique has been applied in five patients with encouraging results ; three had nonunion of femoral neck fractures and two had avascular necrosis of the femoral head. Technique. Patients with a fractured neck of femur were positioned supine on an orthopaedic traction table and internal fixation performed through a standard lateral approach. When closed reduction was difficult or unac-ceptab!e, open reduction was done through an antero-lateral approach. The anterior margin of gluteus medius is mobi!ised by finger dissection to its insertion into the greater trochanter. The anterior third of the greater trochanter is then osteotomised and the fibres ofgluteus medius split for about 4 cm. The pedicle is shifted anterosuperiorly to the neck of the femur without tension, free bleeding should be seen from the cut surface of the trochanteric fragment at the end ofthe mobilisation. The trochanteric graft is then trimmed and placed in a slot 3 cm by 1 cm Society ofBone and Joint Surgery 0301-620X/91/1R92 $2.00 JBoneJointSurg[Br] 1991 ; 73-B:171-2. made on the anterosuperior aspect of the femoral neck (Fig. 1) and held in place by two cancellous screws. Patients with avascular necrosis of the femoral head are operated on through an antero!ateral approach, and a similar window is cut in the front of the femoral neck. Through this window new channels are created in the head of the femur with a curette, but kept to a minimum to avoid undue weakening of the bone. These channels are packed with corticocancellous strut grafts and the trochanteric pedic!e graft is then placed in the slot and fixed with screws. Discussion. A graft from the greater trochanter based on the attachment of the …