Rotational malalignment after intramedullary nailing of femoral fractures.
OBJECTIVE
Intramedullary nailing has been accepted as the treatment of choice for femoral shaft fractures. The aim of our study was to determine the incidence and implications of rotational malalignment after intramedullary nailing using computed tomography measurements.


METHODS
Cohort study.


METHODS
Patients who postoperatively visited the orthopaedic outpatient and radiology clinics.


METHODS
Seventy-six patients, 59 men and 17 women, with a mean age of 28.4 years (15-88).


METHODS
Patients treated on a fracture table with an antegrade reamed AO nail (n = 46) or Grosse Kempf nail (n = 30) for a unilateral femoral shaft fracture between 1988 and 1998 were included in the study.


METHODS
Patients filled out a questionnaire concerning pain, daily activities, and sport. Oxford, Western Ontario and McMaster University osteoarthritis index, and Harris Hip and Knee Society scores were obtained. Physical exams and computed tomography measurements were established.


RESULTS
Twenty-one patients (28%) were found to have a rotational malalignment of 15degrees or more. There was no significant difference in rotational deformity with either the AO or Grosse Kempf nail. The incidence of malrotation was independent of the fracture level. Patients with a torsional deformity had difficulties with more demanding activities like running, sports, and climbing stairs. Patients with an external rotational malalignment (n = 12) have more functional problems than patients with an internal rotational malalignment (n = 9). Clinically determined rotation differences are not accurate (+/-20degrees) compared with the established computed tomography measurements.


CONCLUSIONS
Rotational malalignment after intramedullary nailing for femoral fractures is found in 28% of the patients in this study. These patients have difficulties with more demanding activities, especially when they have an external torsional deformity.
Department of Orthopaedic, University Medical Centre Nijmegen, The Netherlands.
R L
RL
Jaarsma
D F M
DF
Pakvis
N
N
Verdonschot
J
J
Biert
A
A
van Kampen
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D017760:Bone Malalignment / Q000000981:diagnostic imaging / Q000209:etiology*; D001858:Bone Nails; D015331:Cohort Studies; D005260:Female; D005264:Femoral Fractures / Q000601:surgery*; D005594:Fracture Fixation, Intramedullary / Q000009:adverse effects*; D006801:Humans; D008297:Male; D008875:Middle Aged; D014057:Tomography, X-Ray Computed