Purpose In cases of suspected rotational deformity of the lower limb, in particular in post-traumatic malalignment following closed nailing, there is a lack of adequate reference values. Available publications on leg rotation have either small sample sizes or do not include bilateral or whole leg rotation of healthy legs. This study aimed to determine side-specific reference values of lower limb rotation in a large healthy sample. This may be helpful in acute clinical settings as well as for medical expert opinion. Methods 226 consecutive bilateral lower limb computed tomography (CT) angiographies were screened. 105 patients (210 legs) were included (40 females, 65 males, mean age 67 ± 12 years). Bilateral axial femoral and tibial rotation alignment were independently measured and overall leg rotation was computed by two methods. Distributions, sex, and side differences were analyzed. Results Two-sided paired t tests showed significant differences between right and left for all measurements. The left side showed a more pronounced mean anteversion in the femur of 2.2° (p = 0.002) and the right side higher mean external rotation in the tibia of 2.8° (p < 0.001). Overall leg rotation showed 5.1° more mean external rotation on the right side (p < 0.001) with both methods. Absolute side-to-side whole leg rotation difference was 9.5°. Absolute differences between both methods were 3.3°. The variance was high. 23 femora were retroverted, 1 tibia internally rotated, and 9 legs were overall internally rotated. No variables differed between female and male subjects except for femoral version (right p = 0.003 and left p = 0.002). Correlation coefficients were high (rho 0.550–0.934, all p < 0.001). Conclusion There is a significant prevalence of side-to-side asymmetry in femoro-tibial torsion. Although side-to-side differences are not extraordinary, comparative axial femoro-tibial rotation alignment should always be interpreted with caution. Level of evidence Diagnostic, retrospective cohort study, level III.

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Background Economic burden and personnel shortages lead to a reduction in the time spent on surgical training of young resident physicians. This underlines the importance of courses for learning and optimizing surgical skills. Particularly for orthopaedic trauma surgery, training on fractured cadaveric specimens has proven highly useful. The present study investigates a method to induce realistic fracture patterns in fresh frozen elbow specimens, leaving the skin and soft tissue envelope intact. Methods For fracture simulation, 10 human cadaveric specimens with intact soft tissue envelopes were placed in 90° flexion in a custom-made high-impact test bench and compressed by an impactor. The fractures were subsequently classified using conventional x‑rays. Results Of the 10 specimens, 6 could be classified as distal humerus fractures and 4 as olecranon fractures. The fractures of the distal humerus were mainly type C according to Arbeitsgemeinschaft Osteosynthesefragen (AO) criteria, the olecranon fractures were mainly type IIB according to the Mayo classification. Subsequently, all 10 specimens would have been appropriate for use in musculoskeletal trauma courses. Conclusion With the given setup it was possible to induce realistic fracture patterns in fresh frozen cadaveric specimens. The advantage of the presented technique lies in the preservation of soft tissue. With their intact soft tissue envelopes, these pre-fractured preparations could be used in courses to precisely train resident physicians directly on human cadaver preparations. Further research should focus on finding reliable predictors to improve the precision of fracture induction in specimens.