Soft tissue injury occurs when using a piriformis portal for femoral nailing. Standard trochanteric portals also can injure
the gluteus medius and external rotator tendons, which may be a source of hip pain after nailing. On the lateral facet of
the greater trochanter, a “bald spot” may exist that is devoid of tendon insertion. This may be a potential portal for intramedullary
nail insertion. We defined the dimensions and location of this region. Cadaveric specimens were dissected to expose the tendon
insertions on the greater trochanter. A computer navigation system was used with a stylus and bone morphing to determine the
tendon insertions and bald spot anatomy. The greater trochanteric bald spot is covered by the subgluteus medius bursa and
has no tendon insertions. Its center lies 11 mm distal to the tip of the greater trochanter and 5 mm anterior to the midline.
The shape is ellipsoid with a diameter of 21 mm. This region is large enough to accommodate the size of most nailing system
reamers without tendon footprint infringement. Use of this modified entry site may reduce soft tissue injury with nailing
procedures and minimize subsequent hip pain.
One or more of the authors (MJG, DGL) have received funding from Synthes.
Each author certifies that his or her institution has approved the human protocol for this investigation, that all investigations
were conducted in conformity with ethical principles of research, and that informed consent for participation in the study
was obtained.