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Preoperative virtual reduction reduces femoral malrotation in the treatment of bilateral femoral shaft fractures

  • Trauma Surgery
  • Published:
Archives of Orthopaedic and Trauma Surgery Aims and scope Submit manuscript

Abstract

Introduction

In bilateral femoral shaft fractures, significant malrotation (>15°) occurs in about 40 % of cases after intramedullary nailing. Most of the methods that provide rotational control during surgery are based on a comparison to the intact femur and, thus, not applicable for bilateral fractures. In this study, we evaluated if preoperative virtual reduction can help improving rotational alignment in patients with bilateral femoral shaft fractures.

Materials and methods

Seven patients with bilateral femoral shaft fractures were initially treated with external fixation of both femurs. After obtaining a CT scan of both legs, the fractures were reduced virtually using the software program VoXim®, and the amount and direction of rotational correction were calculated. Subsequently, the patients were treated by antegrade femoral nailing and rotation was corrected to the preoperatively calculated amount.

Results

After external fixation, the mean rotational difference between both legs was 15.0° ± 10.2°. Four out of seven patients had a significant malrotation over 15°. Following virtual reduction, the mean rotational difference between both legs was 2.1° ± 1.2°. After intramedullary nailing, no case of malrotation occurred and the mean rotational difference was 6.1° ± 2.8°.

Conclusions

Preoperative virtual reduction allows determining the pretraumatic femoral antetorsion and provided useful information for the definitive treatment of bilateral femoral shaft fractures. We believe that this procedure is worth being implemented in the clinical workflow to avoid malrotation after intramedullary nailing.

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References

  1. Wu CC, Shih CH (1992) Simultaneous bilateral femoral shaft fractures. J Trauma 32:289–293

    Article  CAS  PubMed  Google Scholar 

  2. Citak M, Suero EM, O’Loughlin PF, Arvani M, Hufner T, Krettek C, Citak M (2011) Femoral malrotation following intramedullary nailing in bilateral femoral shaft fractures. Arch Orthop Trauma Surg 131:823–827

    Article  PubMed  Google Scholar 

  3. Wolinsky PR, McCarty E, Shyr Y, Johnson K (1999) Reamed intramedullary nailing of the femur: 551 cases. J Trauma 46:392–399

    Article  CAS  PubMed  Google Scholar 

  4. Winquist RA, Hansen ST Jr, Clawson DK (2001) Closed intramedullary nailing of femoral fractures. A report of five hundred and twenty cases. J Bone Joint Surg Am 83-A:1912

    CAS  PubMed  Google Scholar 

  5. Braten M, Terjesen T, Rossvoll I (1993) Torsional deformity after intramedullary nailing of femoral shaft fractures. Measurement of anteversion angles in 110 patients. J Bone Joint Surg Br 75:799–803

    CAS  PubMed  Google Scholar 

  6. Jaarsma RL, Pakvis DF, Verdonschot N, Biert J, van Kampen A (2004) Rotational malalignment after intramedullary nailing of femoral fractures. J Orthop Trauma 18:403–409

    Article  CAS  PubMed  Google Scholar 

  7. Tornetta P III, Ritz G, Kantor A (1995) Femoral torsion after interlocked nailing of unstable femoral fractures. J Trauma 38:213–219

    Article  PubMed  Google Scholar 

  8. Krettek C, Miclau T, Grun O, Schandelmaier P, Tscherne H (1998) Intraoperative control of axes, rotation and length in femoral and tibial fractures. Technical note. Injury 29(Suppl 3):C29–C39

    Article  PubMed  Google Scholar 

  9. Kuo TY, Skedros JG, Bloebaum RD (2003) Measurement of femoral anteversion by biplane radiography and computed tomography imaging: comparison with an anatomic reference. Invest Radiol 38:221–229

    PubMed  Google Scholar 

  10. Jaarsma RL, Verdonschot N, van der Venne R, van Kampen A (2005) Avoiding rotational malalignment after fractures of the femur by using the profile of the lesser trochanter: an in vitro study. Arch Orthop Trauma Surg 125:184–187

    Article  CAS  PubMed  Google Scholar 

  11. Citak M, Citak M, Kendoff D, O’Loughlin PF, Tavassol F, Jagodzinski M, Krettek C, Hufner T (2009) Estimation of pretraumatic femoral antetorsion in bilateral femoral shaft fractures. Skeletal Radiol 38:1183–1187

    Article  PubMed  Google Scholar 

  12. Stubig T, Min W, Arvani M, Hawi N, Krettek C, Citak M (2012) Accuracy of measurement of femoral anteversion in femoral shaft fractures using a computer imaging software: a cadaveric study. Arch Orthop Trauma Surg 132:613–616

    Article  PubMed  Google Scholar 

  13. Suero EM, Hufner T, Stubig T, Krettek C, Citak M (2009) Use of a virtual 3D software for planning of tibial plateau fracture reconstruction. Injury 41:589–591

    Article  PubMed  Google Scholar 

  14. Jend HH (1986) Computed tomographic determination of the anteversion angle. Premises and possibilities. Rofo 144:447–452

    Article  CAS  PubMed  Google Scholar 

  15. Hawi N, Kabbani AR, O’Loughlin P, Krettek C, Citak M, Liodakis E (2013) Intraoperative measurement of femoral antetorsion using the anterior cortical angle method: a novel use for smartphones. Int J Med Robot 9:29–35

    Article  PubMed  Google Scholar 

  16. Weil YA, Gardner MJ, Helfet DL, Pearle AD (2007) Computer navigation allows for accurate reduction of femoral fractures. Clin Orthop Relat Res 460:185–191

    PubMed  Google Scholar 

  17. Kendoff D, Citak M, Gardner MJ, Gosling T, Krettek C, Hufner T (2007) Navigated femoral nailing using noninvasive registration of the contralateral intact femur to restore anteversion. Technique and clinical use. J Orthop Trauma 21:725–730

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Trauma Department, Hannover Medical School, Carl-Neuberg-Straße 1, 30625, Hannover, Germany

    Mohamed Omar, Eduardo M. Suero, Nael Hawi, Sebastian Decker, Christian Krettek & Musa Citak

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  1. Mohamed Omar
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  2. Eduardo M. Suero
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  3. Nael Hawi
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  4. Sebastian Decker
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  5. Christian Krettek
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  6. Musa Citak
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Correspondence to Mohamed Omar.

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All authors disclose any financial and personal relationships with other people or organisations that could inappropriately influence their work.

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Omar, M., Suero, E.M., Hawi, N. et al. Preoperative virtual reduction reduces femoral malrotation in the treatment of bilateral femoral shaft fractures. Arch Orthop Trauma Surg 135, 1385–1389 (2015). https://doi.org/10.1007/s00402-015-2285-8

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  • DOI: https://doi.org/10.1007/s00402-015-2285-8

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