title: Compensation for rotational malalignment after intramedullary nailing for femoral shaft fractures. An analysis by plantar pressure measurements during gait.
abstract: BACKGROUND
  Even though rotational malalignment due to a femoral shaft fracture leads to clinical complaints, a large number of patients may have none of significance. The ability to compensate may play a role. The purpose of this study is to give insight into aspects of compensatory gait of patients with a femoral malrotation and the relation with clinical complaints.
  
  
  METHODS
  In a cross-sectional laboratory setting, foot-progression angles (FPA) during gait were measured using a foot scan device. Results were related to CT determined femoral torsion and clinical complaints.
  
  
  RESULTS
  Patients with external (EMR) or internal malrotation (IMR) showed differences in foot-progression angles (DeltaFPA) in the same direction of their malrotation. Compared to IMR patients, EMR patients appeared to compensate less for their malrotation. No statistically significant differences were detected between these groups for absolute and relative compensation. EMR patients scored worse at the Oxford 12-item and WOMAC score and experienced more problems executing demanding activities than do patients without malrotation. Correlations were found between Oxford 12-item and WOMAC score and relative compensation.
  
  
  CONCLUSIONS
  Femoral torsion and the FPA are strongly related. All patients compensate towards normal values of FPA at their fractured side. Patients who are less able to compensate have more physical complaints. EMR patients tend to have more complaints and difficulty compensating.
authors.affiliation: Department of Orthopaedics, University Medical Centre St. Radboud, PO Box 9101, 6500 HB Nijmegen, The Netherlands. r.jaarsma@orthop.umcn.nl
authors.forename: R L
authors.initials: RL
authors.lastname: Jaarsma
authors.forename: B F
authors.initials: BF
authors.lastname: Ongkiehong
authors.forename: C
authors.initials: C
authors.lastname: Grüneberg
authors.forename: N
authors.initials: N
authors.lastname: Verdonschot
authors.forename: J
authors.initials: J
authors.lastname: Duysens
authors.forename: A
authors.initials: A
authors.lastname: van Kampen
mesh_terms: D000222:Adaptation, Physiological / Q000502:physiology; D000328:Adult; D017760:Bone Malalignment / Q000503:physiopathology; D001858:Bone Nails; D003430:Cross-Sectional Studies; D005260:Female; D005264:Femoral Fractures / Q000473:pathology / Q000503:physiopathology* / Q000601:surgery; D005269:Femur / Q000473:pathology; D005528:Foot / Q000503:physiopathology; D005594:Fracture Fixation, Intramedullary / Q000379:methods*; D005684:Gait / Q000502:physiology*; D006801:Humans; D008297:Male; D011312:Pressure; D012399:Rotation; D013997:Time Factors; D014057:Tomography, X-Ray Computed / Q000379:methods