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Musculoskeletal Trauma |
Question
A 49-year-old man has a persistent Trendelenburg gait after undergoing open reduction and internal fixation of a posterior wall acetabular fracture 6 months ago. The radiographs reveal a normal joint space with no heterotopic ossification and no signs of osteonecrosis. Weakness in what muscle group is the most likely cause of his limp?
1. Gluteus maximus
2. Gluteus medius
3. Tensor fascia lata
4. Iliopsoas
5. Vastus lateralis
Figures
Answer (click for answer)
2- Gluteus medius: This is the best answer here because the gluteus medius is the strongest abductor of the hip. Paralysis of this muscle causes the classic Trendelenburg gait in which the patient cannot prevent the hip from adducting whenever weight is put on the affected leg during walking.
Reference: Hoppenfeld S, deBoer P (eds): Surgical Exposures in Orthopaedics: The Anatomic Approach. Philadelphia, PA, Lippincott Williams & Wilkins, 1984, pp 353-386.