title: Torsional malalignment, how much significant in the trochanteric fractures?
abstract: OBJECTIVE
  The rotational alignment is definitely important in the long bones such as tibias and femurs. We also predict the importance of rotational alignment in the trochanteric fractures. So we measured torsional malalignment in trochanteric fracture and anlaysed their risk factors and their clinical significance.
  
  
  METHODS
  A total of 109 inpatients who had undergone internal fixation following trochanteric fracture and a postoperative pelvic CT scan between 2008 and 2013, with at least one year follow-up, were selected. Factors that affect torsional malalignment, such as age, gender, fracture stability, injured area, operative time, time of surgery after admission, and ASA status, were investigated. Factors that affect the patients' clinical results in malrotation, including ambulation time after surgery, postoperative complication rates, pain assessment of VAS one year postoperatively and Koval score, were also investigated.
  
  
  RESULTS
  Of the 109 subjects, torsional malalignment was observed in 28 (25.7%) subjects with a mean torsional malalignment angle of 20.7° (range: -31.2° to 27.1°). Torsional malalignment risk factors were fracture stability (p=0.021) and operative time (p=0.043). In terms of the time to ambulation after surgery, the postoperative complication rates, and the VAS and Koval scores at one year postoperatively, no statistically significant difference was observed between the torsional malalignment patients and the non-deformity patients.
  
  
  CONCLUSIONS
  In this study, 25.7% of the patients who had undergone internal fixation following trochanteric fracture experienced torsional malalignment. Major factors of the torsional malalignment were an unstable fracture and the consequent delay in the operative time. But the torsional malalignment was deemed to have no effect on clinical results.
authors: Department of Orthopedic Surgery, School of Medicine, Hallym University, Chuncheon, Republic of Korea. Electronic address: tykim@hallym.or.kr.
authors: Tae Young
authors: TY
authors: Kim
authors: Department of Orthopedic Surgery, School of Medicine, Hallym University, Chuncheon, Republic of Korea. Electronic address: drleeyb1@hallym.or.kr.
authors: Yong Beom
authors: YB
authors: Lee
authors: Department of Orthopedic Surgery, School of Medicine, Hallym University, Chuncheon, Republic of Korea. Electronic address: jdchang@hallym.or.kr.
authors: Jun Dong
authors: JD
authors: Chang
authors: Department of Orthopedic Surgery, School of Medicine, Hallym University, Chuncheon, Republic of Korea. Electronic address: sslee@hallym.or.kr.
authors: Sang Soo
authors: SS
authors: Lee
authors: Department of Orthopedic Surgery, School of Medicine, Hallym University, Chuncheon, Republic of Korea. Electronic address: oships@hallym.or.kr.
authors: Jae Hyun
authors: JH
authors: Yoo
authors: Department of Orthopedic Surgery, School of Medicine, Hallym University, Chuncheon, Republic of Korea. Electronic address: chungkjmed@dreamwiz.com.
authors: Kook Jin
authors: KJ
authors: Chung
authors: Department of Orthopedic Surgery, School of Medicine, Hallym University, Chuncheon, Republic of Korea. Electronic address: hwangjihyo7309@gmail.com.
authors: Ji Hyo
authors: JH
authors: Hwang
mesh_terms: D000328:Adult; D000368:Aged; D017760:Bone Malalignment / Q000000981:diagnostic imaging* / Q000209:etiology; D001860:Bone Plates; D001863:Bone Screws; D005260:Female; D005594:Fracture Fixation, Intramedullary / Q000379:methods*; D017102:Fracture Healing; D006620:Hip Fractures / Q000150:complications / Q000000981:diagnostic imaging / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000000981:diagnostic imaging* / Q000209:etiology; D014057:Tomography, X-Ray Computed; D014102:Torsion Abnormality / Q000000981:diagnostic imaging* / Q000209:etiology
keywords: Femur; Torsional malalignment; Trochanteric fracture