The Clinical Relevance of the Rotational Deformity after Femoral Shaft Fracture Treated with Intramedullary Nailing

Abstract

Objective: The clinical relevance of the rotational deformities after the femoral shaft fracture treated with intramedullary osteosynthesis was evaluated. Symptoms and the amount of the malrotation were compared. To obtain a better insight into the clinical relevance, the anteversion angles of fifteen healthy volunteers were measured by CT and compared with the results of the patient group.
Setting and Design: In a retrospective study, interviews and examinations were possible in thirty-four patients. Patient's complaints were classified in four categories: none, little, moderate, and severe. Physical examination was performed in the prone and supine positions, using the neutral-0-method. The measurements obtained from these patients were related to a CT analysis according to Mesgardzadeh, a method accurate to ± 1°.
Results: No association is shown between the complaints and the amount of the malrotation. Most patients with severe complaints had little malrotations and only one patient with daily symptoms had a malrotation above the 20° endorotation. Measurements in physical examination did not correspond to the amount of the malformation obtained by CT either. In a paired Student t-test p = 0.39 when the physical examination in the prone position and CT measurements were related and p = 0.55 when the physical examination in the supine position and CT measurements were related.
Conclusion: This study shows that the amount of the rotational deformity as determined by CT scan following an intramedullary nailing of the femur does not correlate well with a patient's complaints or physical examination. This finding lends to the support that intramedullary nailing of the femur has little clinical relevance.

Key words

Rotational deformity - Femoral fracture - Intramedullary nailing

References

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