title: Lower limb malrotation following MIPO technique of distal femoral and proximal tibial fractures.
abstract: OBJECTIVE
  To determine the incidence of rotational malalignment in distal femoral and proximal tibial fractures using computed tomography (CT) scanograms following indirect reduction and internal fixation with the minimally invasive percutaneous osteosynthesis (MIPO) technique.
  
  
  METHODS
  Prospective Cohort.
  
  
  METHODS
  Level I Trauma Centre.
  
  
  METHODS
  A total of 27 consecutive subjects, and 14 proximal tibia and distal femur fractures.
  
  
  METHODS
  All patients underwent indirect reduction and internal fixation with a MIPO plating system. A CT scanogram to measure rotational malalignment between the injured and non-injured extremity was then undertaken.
  
  
  METHODS
  Femoral anteversion angles and tibial rotation angles between the injured and non-injured extremities were compared. Malrotation was defined as a side-to-side difference of >108.
  
  
  RESULTS
  A total of 14 postoperative tibias and 13 femurs underwent CT scanograms. Three females and 11 males with an average age of 38.1 years sustained proximal tibia fractures and six females and seven males with an average age of 55.8 years sustained distal femur fractures. The difference between tibial rotation in the injured and the non-injured limbs ranged from 2.7 to 40.08 with a mean difference of 16.28(p = 0.656, paired T-test). Fifty percent of the tibias fixed with MIPO plates were malrotated >108 from the uninjured limbs. The difference between femoral anteversion in the injured and non-injured limbs ranged from 2.0 to 31.38 with a mean difference of 11.58 (p = 0.005, paired T-test). A total of 38.5% of the distal femurs fixed with MIPO plates were malrotated >108 from the uninjured limb.
  
  
  CONCLUSIONS
  Following fixation of distal femoral and proximal tibial fractures, the incidence of malrotation was 38.5% and 50%, respectively. The difference of the mean measures was significant for femoral malrotation; however, statistical significance could not be demonstrated for tibial malrotation.The incidence of malrotation following MIPO plating in this study is much higher than that quoted in previous studies.
authors.affiliation: Foothills Medical Centre, AC144A, 1403 – 29th Street NW, Calgary, AB, Canada T2N 2T9. buckclin@ucalgary.ca
authors.forename: R
authors.initials: R
authors.lastname: Buckley
authors.forename: K
authors.initials: K
authors.lastname: Mohanty
authors.forename: D
authors.initials: D
authors.lastname: Malish
mesh_terms: D000328:Adult; D017760:Bone Malalignment / Q000000981:diagnostic imaging* / Q000209:etiology / Q000503:physiopathology; D005260:Female; D005264:Femoral Fractures / Q000000981:diagnostic imaging* / Q000503:physiopathology / Q000601:surgery; D005594:Fracture Fixation, Intramedullary / Q000009:adverse effects*; D017102:Fracture Healing / Q000502:physiology; D006801:Humans; D008297:Male; D011446:Prospective Studies; D013978:Tibial Fractures / Q000000981:diagnostic imaging* / Q000503:physiopathology / Q000601:surgery; D014057:Tomography, X-Ray Computed