Femoral malrotation following intramedullary nailing in bilateral femoral shaft fractures

Abstract

Bilateral femoral shaft fractures are associated with a high incidence of clinically relevant femoral malrotation over 15°. Measurement of intraoperative femoral antetorsion in bilateral femoral shaft fractures is quite difficult and currently only feasible postoperatively.

Preoperative virtual reduction reduces femoral malrotation in the treatment of bilateral femoral shaft fractures

“…According to the literature, postoperative malrotation occurs in 4 out of 10 cases of intramedullary nailing in bilateral femoral fracture [2]. This is most likely due to the lack of an intact femur from which to obtain a native torsion reference value.…”

“…Since this technique does not rely upon open anatomical reduction, it is technically challenging and may result in considerable malrotation. While significant malrotation ([15°) occurs in up to 30 % of patients with unilateral femoral shaft fractures [5,6], the rate is even 40 % in bilateral femoral shaft fractures [1,2].…”

“…The incidence of bilateral femoral shaft fractures is low [1,2]. They are most commonly treated by closed reduction and intramedullary nailing [3,4].…”

Current state of computer-assisted trauma surgery

“…A higher incidence of significant malrotation in bilateral femoral shaft fractures compared with unilateral femoral shaft fractures have been reported by Citak et al [34]. Navigation assisted femoral nailing prevents pronounced malrotations and extensive radiation, which often occur routinely in the context of reduction and interlocking control.…”

Improving the human–robot interface for telemanipulated robotic long bone fracture reduction: Joystick device vs. haptic manipulator

“…6 Despite its high success rate, closed reduction is technically challenging and it is associated with unwanted side effects, such as high intraoperative radiation exposure and postoperative rotational malalignment. [7][8][9][10] Several technological advances aimed at improving outcomes after femoral nailing have been described. Computer navigation has been available for over 10 years and it has proven to be a useful tool in the treatment of femoral fractures.…”