title: Computerized navigation for length and rotation control in femoral fractures: a preliminary clinical study.
abstract: OBJECTIVE
  Operative treatment of femoral fractures yields a predictably high union rate, but residual malrotation and leg length discrepancy remain a clinically significant problem. The aim of this study was to determine the safety and efficacy of using computerized navigation in controlling the length and rotation in femoral fracture surgery.
  
  
  METHODS
  Prospective consecutive case series of 16 skeletally mature patients with femoral fractures undergoing surgical fixation; 14 were fixed with intramedullary nails and 2 with plates.
  
  
  METHODS
  An Academic Level I trauma center.
  
  
  METHODS
  Computerized navigation was used to determine the length and rotation of the operated extremity as compared with the intact healthy contralateral side.
  
  
  METHODS
  All patients underwent postoperative computed tomography scanogram for determining the length and rotation.
  
  
  RESULTS
  All fractures healed. Mean rotational difference between the treated and nontreated sides was 3.45 degrees (range, 0-7.7 degrees). Mean length difference between the 2 extremities as calculated by the computed tomography scan was 5.83 mm (range, 0-13 mm). Additional operative time required for computerized navigation was measured in 2 of the cases and totaled ∼30-35 min/case.
  
  
  CONCLUSIONS
  Computerized navigation was accurate and precise at restoring femoral length and rotation during femoral fracture fixation when the intact contralateral femur was used for reference. Further, large-scale randomized studies are required. Additionally, improvements aimed at decreasing operative time and improving user interface of these systems are recommended.
  
  
  METHODS
  Therapeutic level IV. See instructions for authors for a complete description of the levels of evidence.
authors.affiliation: Department of Orthopedic Surgery, Hadassah-Hebrew University Medical Center, Jerusalem, Israel.
authors.forename: Yoram A
authors.initials: YA
authors.lastname: Weil
authors.forename: Alexander
authors.initials: A
authors.lastname: Greenberg
authors.forename: Amal
authors.initials: A
authors.lastname: Khoury
authors.forename: Rami
authors.initials: R
authors.lastname: Mosheiff
authors.forename: Meir
authors.initials: M
authors.lastname: Liebergall
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D017760:Bone Malalignment / Q000000981:diagnostic imaging / Q000209:etiology / Q000517:prevention & control; D005260:Female; D005264:Femoral Fractures / Q000000981:diagnostic imaging / Q000601:surgery*; D005593:Fracture Fixation, Internal / Q000009:adverse effects / Q000379:methods*; D006801:Humans; D007870:Leg Length Inequality / Q000000981:diagnostic imaging / Q000209:etiology / Q000517:prevention & control; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D025321:Surgery, Computer-Assisted; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D055815:Young Adult