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Malrotation following reamed intramedullary nailing of closed tibial fractures.

Jafarinejad AE, Bakhshi H, Haghnegahdar M, Ghomeishi N - Indian J Orthop (2012)

Bottom Line: Malrotation was greater than 15° in seven cases.Good or excellent rotational reduction was achieved in 70% of the patients.There was no statistically significant relation between AO tibial fracture classification and fibular fixation and malrotation of greater than 10°.

View Article: PubMed Central - PubMed

Affiliation: Department of Orthopedic Surgery, Shahid Beheshti University of Medical Sciences, Tehran, Iran.

ABSTRACT

Background: Rotational malalignment after intramedullary tibial nailing is rarely addressed in clinical studies. Malrotation (especially >10°)of the lower extremity can lead to development and progression of degenerative changes in knee and ankle joints. The purpose of this study is to determine the incidence and severity of tibial malrotation after reamed intramedullary nailing for closed diaphyseal tibial fractures.

Materials and methods: Sixty patients (53 males and 7 females) with tibial diaphyseal fracture were included in this study. The mean age of the patients was 33.4±13.3 years. All fractures were manually reduced and fixed using reamed intramedullary nailing. A standard method using bilateral limited computerized tomography was used to measure the tibial torsion. A difference greater than 10° between two tibiae was defined as malrotation.

Results: Eighteen (30%) patients had malrotation of more than 10°. Malrotation was greater than 15° in seven cases. Good or excellent rotational reduction was achieved in 70% of the patients. There was no statistically significant relation between AO tibial fracture classification and fibular fixation and malrotation of greater than 10°.

Conclusions: Considering the high incidence rate of tibial malrotation following intramedullary nailing, we need a precise method to evaluate the torsion intraoperatively to prevent the problem.

No MeSH data available.


Related in: MedlinePlus

Measurement of tibial torsion using CT scanning. The proximal reference line is a line drawn as tangent to posterior tibial cortex in the cut just proximal to the fibular head (a, a1). The distal reference line is a line that connects the tibial and fibular centers in the cut just proximal to the tibial plafond (b, b1). The torsion angle is the angle between perpendicular lines to two reference lines
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Figure 1: Measurement of tibial torsion using CT scanning. The proximal reference line is a line drawn as tangent to posterior tibial cortex in the cut just proximal to the fibular head (a, a1). The distal reference line is a line that connects the tibial and fibular centers in the cut just proximal to the tibial plafond (b, b1). The torsion angle is the angle between perpendicular lines to two reference lines

Mentions: A limited (few cuts) bilateral CT scan imaging was performed before each patient was discharged. A standard method similar to previous studies was used to determine tibial torsion.4679 In supine position, both legs were gently strapped together to minimize the movement. CT scan images were prepared from 3–4 axial cuts in the proximal and 3–4 axial cuts in the distal part of tibia. Proximal cuts were taken 2–3 mm above the proximal tibiofibular joint and distal cuts were taken just proximal to the tibiotalar articulation. The proximal reference line is a line drawn as tangent to posterior tibial cortex in the cut just proximal to the fibular head. The distal reference line is a line that connects the tibial and fibular centers in the cut just proximal to the tibial plafond. The torsion angle is the angle between perpendicular lines to two reference lines [Figures 1 and 2]. The unaffected side was used as the control. Malrotation was defined as torsional difference greater than 10° between the fractured and unaffected sides. Positive values were considered as external rotation and negative values as internal rotation. The intra-observer reliability determined in a pilot study was 0.9 approximately.


Malrotation following reamed intramedullary nailing of closed tibial fractures.

Jafarinejad AE, Bakhshi H, Haghnegahdar M, Ghomeishi N - Indian J Orthop (2012)

Measurement of tibial torsion using CT scanning. The proximal reference line is a line drawn as tangent to posterior tibial cortex in the cut just proximal to the fibular head (a, a1). The distal reference line is a line that connects the tibial and fibular centers in the cut just proximal to the tibial plafond (b, b1). The torsion angle is the angle between perpendicular lines to two reference lines
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3377142&req=5

Figure 1: Measurement of tibial torsion using CT scanning. The proximal reference line is a line drawn as tangent to posterior tibial cortex in the cut just proximal to the fibular head (a, a1). The distal reference line is a line that connects the tibial and fibular centers in the cut just proximal to the tibial plafond (b, b1). The torsion angle is the angle between perpendicular lines to two reference lines
Mentions: A limited (few cuts) bilateral CT scan imaging was performed before each patient was discharged. A standard method similar to previous studies was used to determine tibial torsion.4679 In supine position, both legs were gently strapped together to minimize the movement. CT scan images were prepared from 3–4 axial cuts in the proximal and 3–4 axial cuts in the distal part of tibia. Proximal cuts were taken 2–3 mm above the proximal tibiofibular joint and distal cuts were taken just proximal to the tibiotalar articulation. The proximal reference line is a line drawn as tangent to posterior tibial cortex in the cut just proximal to the fibular head. The distal reference line is a line that connects the tibial and fibular centers in the cut just proximal to the tibial plafond. The torsion angle is the angle between perpendicular lines to two reference lines [Figures 1 and 2]. The unaffected side was used as the control. Malrotation was defined as torsional difference greater than 10° between the fractured and unaffected sides. Positive values were considered as external rotation and negative values as internal rotation. The intra-observer reliability determined in a pilot study was 0.9 approximately.

Bottom Line: Malrotation was greater than 15° in seven cases.Good or excellent rotational reduction was achieved in 70% of the patients.There was no statistically significant relation between AO tibial fracture classification and fibular fixation and malrotation of greater than 10°.

View Article: PubMed Central - PubMed

Affiliation: Department of Orthopedic Surgery, Shahid Beheshti University of Medical Sciences, Tehran, Iran.

ABSTRACT

Background: Rotational malalignment after intramedullary tibial nailing is rarely addressed in clinical studies. Malrotation (especially >10°)of the lower extremity can lead to development and progression of degenerative changes in knee and ankle joints. The purpose of this study is to determine the incidence and severity of tibial malrotation after reamed intramedullary nailing for closed diaphyseal tibial fractures.

Materials and methods: Sixty patients (53 males and 7 females) with tibial diaphyseal fracture were included in this study. The mean age of the patients was 33.4±13.3 years. All fractures were manually reduced and fixed using reamed intramedullary nailing. A standard method using bilateral limited computerized tomography was used to measure the tibial torsion. A difference greater than 10° between two tibiae was defined as malrotation.

Results: Eighteen (30%) patients had malrotation of more than 10°. Malrotation was greater than 15° in seven cases. Good or excellent rotational reduction was achieved in 70% of the patients. There was no statistically significant relation between AO tibial fracture classification and fibular fixation and malrotation of greater than 10°.

Conclusions: Considering the high incidence rate of tibial malrotation following intramedullary nailing, we need a precise method to evaluate the torsion intraoperatively to prevent the problem.

No MeSH data available.


Related in: MedlinePlus