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CT analysis of femoral malrotation after intramedullary nailing of trochanteric fractures

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

Abstract

Purpose

Functional results after internal fixation of trochanteric femoral fractures may be negatively affected by healing in a non-physiological position. The aim of this study was to evaluate the occurrence and severity of femoral malrotation after nailing of trochanteric fractures.

Materials and methods

The authors conducted a prospective study focused on a CT analysis of malrotation after intramedullary nailing of trochanteric fractures (AO 31A1-3) in 101 patients. We recorded the type of fracture, method of anesthesia, scheduled surgery vs. acute surgery, and the surgeon’s experience as possible risk factors for limb malrotation after trochanteric fracture surgeries.

Results

The average extent of malrotation was 9° of internal rotation ranging from 29° of external to 48°of internal rotation. In 35% of patients, we observed a rotation greater than 15°, and in 15 patients (15%), the rotation was greater than 25°. The risk of significant internal malrotation was significantly higher than external malrotation (37 vs. 4 patients). None of the factors observed proved to be statistically significant. The effect of general anesthesia and the type of intertrochanteric fracture came closest to having a significant effect on rotational error.

Conclusion

Improper reduction of a trochanteric fracture is a common problem that can lead to femur malrotation. In our study, a rotational error greater than 15° occurred in 35% of the patients, but none of the monitored factors represented a statistically significant risk for this complication.

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Availability of data and materials

The data used and analyzed during the current study are available from the corresponding author on reasonable request.

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Authors and Affiliations

  1. Department of Orthopaedics and Traumatology, Third Faculty of Medicine, Charles University, University Hospital Kralovske Vinohrady, Prague, Czech Republic

    Jakub Maléř, Valér Džupa, Jiří Marvan & Jiří Skála-Rosenbaum

  2. Faculty of Medicine, Charles University, Plzeň, Czech Republic

    Jakub Maléř

  3. Department of Radiology, Third Faculty of Medicine, Charles University, University Hospital Kralovske Vinohrady, Prague, Czech Republic

    Michal Buk & Martin Michna

Authors
  1. Jakub Maléř
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  2. Valér Džupa
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  3. Michal Buk
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  4. Martin Michna
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  6. Jiří Skála-Rosenbaum
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Contributions

Maléř J. has designed the study, analyzed and interpreted the data, and drafted the manuscript; Skála-Rosenbaum J. has conceptualized the study, interpreted the data, and revised the manuscript; Džupa V. and Marvan J. have revised the manuscript. Buk M. and Michna M. collected CT data and have performed the CT analysis. All the authors have approved the final manuscript as submitted.

Corresponding author

Correspondence to Jiří Skála-Rosenbaum.

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Conflict of interest

There was no financial or personal relationships with other people or organizations that could inappropriately influence the study.

Ethical approval

The study protocol was approved by the Institutional Ethics Committee of University Hospital Kralovske Vinohrady.

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Informed consent was obtained from all individual participants included in the study.

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Informed consent was obtained from all individual participants included in the study.

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Maléř, J., Džupa, V., Buk, M. et al. CT analysis of femoral malrotation after intramedullary nailing of trochanteric fractures. Arch Orthop Trauma Surg 142, 1865–1871 (2022). https://doi.org/10.1007/s00402-021-03902-3

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