Malrotation of the femur has been documented in as few as 0% and as many as 28% of fractures treated with an intramedullary(IM) nail. Patients with more than 15 degrees of malrotation sometimes require derotation osteotomy. Recognizing malrotation intraoperatively is the most efficient way to avoid corrective surgery. The purpose of this paper is to inform orthopaedic surgeons of the best estimate of incidence of femoral malrotation after IM nailing. This may lead to increased attention toward intraoperative control of malrotation. A literature search was performed by a library sciences professional. Two authors excluded papers not relevant to the study in two stages with clearly outlined criteria and adjudication. Inter-observer agreement was measured with the kappa statistic. Data extraction was performed by the same two authors with measure of agreement and adjudication from a third author. Data extraction included: incidence of malrotation, method used for measurement of malrotation and use of intraoperative techniques to minimize malrotation.Purpose
Method
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
Method
