Behandlung von Torsionsabweichungen am Unterschenkel

Keppler, P.

doi:10.1007/s00113-017-0452-9

Cited by 6 publications

(3 citation statements)

References 55 publications

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“…In general, any malrotation of the femur comes with impairment in patient outcomes, regardless of location, when considering osteosynthesis. While issues with malrotation in the femoral shaft are described [11,12,17,[21][22][23][24][25], Male ´ř et al report a doubling of cutout rate when malrotation exceeds 15˚in the intertrochanteric region, showing the need for anatomic reduction [26]. Fractures of the basicervical femoral neck are treated with osteosynthesis.…”

Section: Discussionmentioning

confidence: 99%

Validation of direct CT measurement of malrotation in femoral neck fractures: A bone model study

et al. 2023

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Background While postoperative malrotation in the subtrochanteric region is a well-known problem, malrotation after osteosynthesis in proximal femoral fractures has not been extensively studied. In this context, many methods for perioperatively assessment of femoral torsion have been described, but none of them is applicable in the basicervical region of the proximal femur. As an important difference in femoral neck fractures, the discontinuous neck fails to serve as a significant “pointer” for measurements and malfunctions to be placed in relation to the condylar plane. Considering postoperative maltorsion at any location as a substantial negative effect on patients’ outcome and functional expectations, precise and patient-friendly rotation measurement standards in femoral neck fractures are desired in clinical practice. Recently, a novel computed tomography (CT) based geometric technique was described named “direct measurement” with promising results covering this diagnostic disparity, but still requires validation. Thus, we aimed to validate the previously described technique using a controlled range of displacement in a femoral neck fracture Sawbone® model. Methods and findings A goniometer was designed to set retro- and anteversion of the proximal femur in a reproducible manner. Prospectively, all femurs underwent a CT scan and were measured 3D for displacement. The interclass correlation between the CT measurements and the goniometer measurements was calculated and was found to be very high (1.00, 95% confidence interval: 0.99–1.00; p < 0.001). For the mean of all measurements, the Pearson’s correlation was 1.00 (p < 0.001). No significant differences in the measurements of both investigators were observed, with 20° of retroversion not significant (-1.20 ± 1.71; 95% confidence interval: -2.43–0.03; p = 0.054). Conclusion This CT-based 3D measurement technique may allow for perioperative malrotation assessment in basicervical femoral neck fractures and appears to be feasible in femoral neck fractures when it comes to rare cases of osteosynthesis. Further investigations are still needed to define the thresholds of malrotation provoking functional impairment after osteosynthesis in basicervical femoral neck fractures.

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Section: Discussionmentioning

confidence: 99%

Validation of direct CT measurement of malrotation in femoral neck fractures: A bone model study

et al. 2023

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“…Torsional malalignment after shaft fractures of long bones is a very well-known clinical complication that can affect both the lower as well as the upper extremity [1][2][3][4][5][6][7].…”

Section: Introductionmentioning

confidence: 99%

Direct measurement of malrotation of traumatic femoral neck fractures after osteosynthesis: Introduction of a novel method and interrater reliability

et al. 2021

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Background In elderly patients, displaced femoral neck fractures are mostly treated by arthroplasty; however for younger patients (<50 years), open reduction and internal fixation is considered the gold standard approach. Despite there being no consensus on the specific procedure, everyday clinical practice in a level I trauma center has shown that postoperative maltorsion after internal fixation of femoral neck fractures can have a significantly worse impact on mobilization and outcome. Different methods for measurement of malrotations are reported in literature. However, any reported method for the assessment of a shaft malrotation in the femur does not work here. In femoral neck fractures, the pointer function of the femoral neck, which is absolutely essential for these techniques, is lost and cannot be set in relation to the condylar plane. These circumstances are not addressed in literature thus far. Therefore, we propose here a novel method to fill this diagnostic gap. Methods and findings Three investigators (1 orthopaedic surgeons and 2 radiologists) measured the torsion of 20 legs on 10 patients using the Jarret method and a new geometric technique. To determine the intraobserver reliability the torsional angles were calculated again after 3 months. We applied a new geometric technique, without the need to include the femoral condyles in the measurement, to directly measure the angulation. For torsional difference, the interrater reliability -ICC (interclass correlation) between all investigators was 0.887 (good) (significance level: 95%CI, 0.668–0.969; p<0.001), by using the method of Jarret et al. and 0.933 (good) for the novel technique (significance level: 95%CI, 0.802–0.982; p<0.001). If the examinations are classified according to the patient side, our data show that for established methods, an ICC between the examiners on the right lower extremity is 0.978 (good) (95%CI, 0.936–0.994; p<0.001) and that on the left extremity is 0.955 (good) (95%CI, 0.867–0.988; p<0.001). Comparing with the new method, the right side assumes an ICC of 0.971 (good) (95%CI, 0.914–0.992; p<0.001), while the left side assumes an ICC of 0.910 (good) (95%CI, 0,736–0.976; p<0.001). When it comes to the intraobserver reliability, the measured cohort shows a significant better ICC for the novel method compared to Jarrett et al, with 0.907 respectively 0.786 for comparison in torsional differences. Conclusion The established methods may fail in assessing this special aspect of malrotation after femoral neck fractures. Here, the method presented results in a significant difference between the injured and uninjured side and shows significant differences in results compared to conventional measurement methods. The inter- and intraobserver reliability determined in this study is excellent and even higher in the assessment of torsional differences than the established method. We believe that the measurement method presented in this study is a useful tool to objectify the postoperative deformities in this area and making therapy recommendations in the future.

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“…Even percutaneous drill holes and closed osteoclasis have been applied to create percutaneous SMOs [10]. Techniques to stabilize SMOs may involve Kirschner wires (K-wires), external fixators, intramedullary nails, locking plates, or screws [12][13][14][15][16]. In children, correctional tibial osteotomy is preferentially done at the distal (supramalleolar) metaphysis since proximal tibia osteotomy is associated with a higher rate of major complications [17].…”

Section: Introductionmentioning

confidence: 99%

Differences between Two Methods to Stabilize Supramalleolar Osteotomies in Children—A Retrospective Case Series

et al. 2021

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Supramalleolar osteotomy (SMO) in pediatric patients can be fixed in various ways. We analyzed the records of 77 pediatric patients (124 SMOs) aged ≤16 years. In 56 patients (96 SMOs), K-wires were used to stabilize SMOs (WF group), while 21 patients (28 SMOs) were treated with locking compression plates (LCPs; PF group). We recorded time to radiographic consolidation, rate of complications, length of hospital stay (LOS), and time to implant removal. Mean time to radiographic consolidation of SMOs was 7.2 weeks in the WF group and 11.1 weeks in the PF group. Complication rate in the WF group was 10.7%. LOS was similar in the two groups (7.0 days in the WF group vs. 7.3 days in the PF group). K-wire stabilization resulted in a shortened interval until consolidation of osteotomies, but children were required to use a cast. Stabilization of SMOs with LCPs facilitated early mobilization and functional rehabilitation with no need to apply a cast. In conclusion, both methods provided safe fixation of SMOs with a low rate of complications. K-wire stabilization combined with a cast achieves fast consolidation of SMOs. We recommend SMO stabilization with angular stable LCPs in patients with muscular weakness or spasticity in whom early mobilization and physiotherapy are necessary to prevent loss of muscle power, muscle function, and bone mass.

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Behandlung von Torsionsabweichungen am Unterschenkel

Cited by 6 publications

References 55 publications

Validation of direct CT measurement of malrotation in femoral neck fractures: A bone model study

Validation of direct CT measurement of malrotation in femoral neck fractures: A bone model study

Direct measurement of malrotation of traumatic femoral neck fractures after osteosynthesis: Introduction of a novel method and interrater reliability

Differences between Two Methods to Stabilize Supramalleolar Osteotomies in Children—A Retrospective Case Series

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