Incidence of malrotation of femoral fractures after intramedullary nailing is as high as 28%. Prevention of malrotation is superior to late derotation osteotomy. The lesser trochanter (LT) profile has been in use for some time as a radiographic landmark of femoral rotation. One of the authors has previously described a linear regression model that describes the relationship of the LT to rotation. This paper aims to validate the use of this equation in predicting femoral rotation. A survey was created and circulated online. Twenty images of cadaveric femurs of known rotation were chosen randomly from a large series. Thirty individuals with varying degrees of orthopaedic experience were invited to participate. Participants were asked to take measurements of the LT in a standardized fashion. Inter-observer variation for predicted rotation and the precision of predicted rotation was calculated. Results were grouped into those with the LT readily visible and those with the LT hidden by the femoral shaft.Purpose
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