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Identification of Tibial Malrotation After Nailing Using Unique CT Scan Reference Line, and Influence of Position of Leg for Distal Locking on Rotation

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Abstract

Introduction

Tibial torsion can be measured by various clinical and radiological methods. Computed tomography (CT) scan measurement is currently the investigation of choice. The purpose of our study was to compare the clinical and CT scan methods to reveal malrotation after nailing of tibia and also to find out if leg position for distal locking has any influence on incidence of malrotation.

Materials and methods

We have included 106 patients (21–68 years) of tibia nailing, and categorised them as category A (figure of four position n = 54) and category B (knee straight position n = 52) based on limb position for distal locking. The plumb line measurement, Thigh Foot Axis (TFA) and CT scan measurement (using new reference line) were documented and compared with the uninjured limb.

Results

We observed plumb line measurement to be the most inaccurate method followed by TFA method. CT scan measurement was the most accurate method showing external rotations (> 10º) in 32 cases (30.1%) and internal rotation (> − 10º) in five cases (4.71%). The TFA method had a sensitivity of 44% and specificity of 86% in identifying malrotations. The interobserver reliability for CT scan measurement was 0.96. Even though statistically not significant (P value), figure of four position for distal locking leads to larger number of malrotations (both external and internal rotation).

Conclusion

CT scan is the most accurate method of measuring malrotation. The new reference line used in our study provides accurate measurement of malrotation. The two different positions of leg for distal locking do not have a statistically significant influence on incidence of malrotation.

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Authors and Affiliations

  1. Department of Orthopaedic Surgery, Chengalpet Medical College Hospital (The TN Dr. MGR Medical University), Chengalpet, Tamil Nadu, India

    D. R. Ramprasath

  2. Institute of Orthopaedics and Traumatology, Coimbatore Medical College Hospital (The TN Dr. MGR Medical University), Coimbatore, Tamil Nadu, 641018, India

    S. Vetrivel Chezian

  3. Government District Head Quarters Hospital, Mettur Dam, Salem, Tamil Nadu, 636401, India

    V. Surendar

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  1. D. R. Ramprasath
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Correspondence to D. R. Ramprasath.

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On behalf of all authors, the corresponding author states that there is no conflict of interest.

Ethical standard statement

This study involved patients with fracture both bones of leg, who were managed in a tertiary care centre with multidisciplinary approach. We have performed only established and time tested procedures on these patients. We have not employed any new experimental methods (including surgical, pharmacological and radiological methods) on these patients. Every procedure was explained in detail to the patient, including the post operative CT scan for measurement of malrotation. We have exercised utmost care to follow the international principles of medical ethics in all our patients. We have also obtained informed consent for surgical aspects as well as for using their clinical and radiological images for scientific study purpose. As a corresponding author, I hold the full responsibility for any ethical related issues in this study.

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The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

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Ramprasath, D.R., Chezian, S.V. & Surendar, V. Identification of Tibial Malrotation After Nailing Using Unique CT Scan Reference Line, and Influence of Position of Leg for Distal Locking on Rotation. JOIO 55, 662–668 (2021). https://doi.org/10.1007/s43465-020-00307-z

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