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Computer-assisted antetorsion control prevents malrotation in femoral nailing: an experimental study and preliminary clinical case series

Archives of Orthopaedic and Trauma Surgery volume 129, pages 1521–1526 (2009)Cite this article

Abstract

Materials and methods

The effect of fluoroscopy-based navigation for femoral fracture reduction on the prevention of malrotation was examined in an experimental setting followed by a first case series. Eleven cadaver femurs were used. All femurs were reduced by closed methods. An optoelectronic navigation system was utilized to check for fragment reduction and alignment. Fluoroscopic control without navigation was used as the control group. The Six Sigma Analysis [offset capability index (C pk) = 1.3] was used to compare the probability of outliers of more than 15°. In the clinical case series the same navigation tool was used in ten non-consecutive patients with femoral fractures. Torsional differences between both legs were measured postoperatively by CT scan.

Results

The highest malrotation in the navigated group was 7.0° for the cadaver testings, while two femurs in the control group showed a difference of more than 10° (10.3°, 17.4°). Only the navigated group showed a sufficient offset capability index (C pk-navigated = 1.83; C pk-conventional = 0.59). In the clinical series nine femurs were successfully reduced by navigation control. The average malrotation was 6.6°. No patient had a torsional difference of more than 10°.

Conclusion

Navigated femoral nailing reduces the risk for outliers of postoperative torsional differences and might avoid revision surgery for malrotation.

Level of evidence

IV.

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Acknowledgments

We thank Dr. Padraigh O’Loughlin for the contribution of his work for this manuscript and Bernhard Vaske for the statistical work.

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Affiliations

  1. Hannover Medical School, Hannover, Germany

    Thomas Gösling, M. Oszwald, D. Kendoff, M. Citak, C. Krettek & T. Hufner

  2. Unfallchirurgische Klinik, Medizinische Hochschule Hannover, Carl-Neuberg-Str. 1, 30625, Hannover, Germany

    Thomas Gösling

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  1. Thomas Gösling
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  2. M. Oszwald
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  3. D. Kendoff
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  4. M. Citak
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  5. C. Krettek
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Correspondence to Thomas Gösling.

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Gösling, T., Oszwald, M., Kendoff, D. et al. Computer-assisted antetorsion control prevents malrotation in femoral nailing: an experimental study and preliminary clinical case series. Arch Orthop Trauma Surg 129, 1521–1526 (2009). https://doi.org/10.1007/s00402-009-0871-3

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  • DOI: https://doi.org/10.1007/s00402-009-0871-3

Keywords

  • Malrotation
  • Navigation
  • Femur
  • Fracture
  • Reduction