[Malalignment of the tibia--comparative investigation of three stabilization procedures by clinical analysis and radiological measuring techniques].
BACKGROUND
Malalignment after osteosynthetic stabilization of lower leg fractures is still a common problem for trauma surgeons. The aim of the present study was to evaluate the incidence of torsional and varus- or valgus-malalignment of the lower leg subsequent to osteosynthetic stabilization techniques such as reamed nailing, unreamed nailing and tibial plating.


METHODS
70 patients with 73 fractures of the lower leg were included in the study. The fractures were treated consecutively in 37 cases with an unreamed nail (UTN), in 21 cases with a reamed nail and 15 cases were stabilized with a plate. During clinical follow-up after 5.7 years each patient was analyzed for malalignment of the lower leg with a CT-Scan and a dual-energy X-ray absorptiometry (DXA) analysis.


RESULTS
Multi-level CT-scans revealed a significant rotational malalignment in 16.4 % of patients. Interestingly, all misaligned cases were treated with a nail (9.6 % UTN, 6.8 % reamed nail). Varus- or valgus-malalignment was detected in 5.4 % of cases all of whom had been treated with an intramedullary nail.


CONCLUSIONS
Malalignment is still a common problem after osteosynthetic stabilization of lower leg fractures, whereby the majority of these cases can be expected after intramedullary nailing. Rotational malalignment can be detected by CT-Scans, whereas DXA analysis is a reliable procedure to diagnose varus- or valgus-malalignment after osteosynthetic stabilization of lower leg fractures.
D015502:Absorptiometry, Photon; D000293:Adolescent; D000328:Adult; D017760:Bone Malalignment / Q000000981:diagnostic imaging / Q000601:surgery*; D001860:Bone Plates; D004868:Equipment Failure; D005260:Female; D005500:Follow-Up Studies; D005593:Fracture Fixation, Internal; D005594:Fracture Fixation, Intramedullary; D005597:Fractures, Open / Q000000981:diagnostic imaging / Q000601:surgery; D006801:Humans; D007870:Leg Length Inequality / Q000000981:diagnostic imaging / Q000601:surgery; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000000981:diagnostic imaging / Q000601:surgery*; D012086:Reoperation; D013978:Tibial Fractures / Q000000981:diagnostic imaging / Q000601:surgery*; D014057:Tomography, X-Ray Computed; D014102:Torsion Abnormality / Q000000981:diagnostic imaging / Q000601:surgery
Vergleichende Untersuchung von drei Stabilisationsverfahren bei Unterschenkelschaftfraktur durch klinische Analyse und radiologische Messtechniken.