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Correcting torsion after intramedullary nailing osteosynthesis of the lower extremity

Intraoperative control of torsion is delicate in intramedullary nailing of femur and tibia fractures. Post-traumatic torsional deformities cause clinical problems if the rotational 0-position, according to the neutral-0-method, cannot be attained or exceeded. The necessary precondition for every ind...

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Published in:Der Unfallchirurg 1997-01, Vol.100 (1), p.29
Main Authors: Strecker, W, Hoellen, I, Keppler, P, Suger, G, Kinzl, L
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Hoellen, I
Keppler, P
Suger, G
Kinzl, L
description Intraoperative control of torsion is delicate in intramedullary nailing of femur and tibia fractures. Post-traumatic torsional deformities cause clinical problems if the rotational 0-position, according to the neutral-0-method, cannot be attained or exceeded. The necessary precondition for every indication and planning of corrective osteotomies is conscientious analysis of the geometry of the lower extremities by clinical means, radiography and computed tomography. Operative procedures and techniques of corrective osteotomies in case of torsional deformities after intramedullary nailing are presented. Preoperatively, the intraindividual torsional differences in 15 patients with maltorsions of the femur were 33 degrees (-37/+50) and in 7 patients with maltorsions of the tibia 23 degrees (-21/+29). Positive signs indicate external and negative signs of internal maltorsions. Postoperatively, the intraindividual torsional differences were 6 degrees (-3/+14) in the femora and 7 degrees (+3/+12) in the tibiae. Therefore, the physiological torsional tolerance of 15 degrees was respected in all 22 patients. Additionally, limb lengthening was realized in 4 patients with shortening after intramedullary nailing of the femur. In 3 patients a one-step procedures with interposition of allogeneic cancellous bone in the osteotomy gap was performed and in one patient continuous callus distraction by external fixation.
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recordid cdi_pubmed_primary_9132952
source Alma/SFX Local Collection
subjects Adult
Female
Femoral Fractures - diagnostic imaging
Femoral Fractures - surgery
Fracture Fixation, Intramedullary
Fractures, Malunited - diagnostic imaging
Fractures, Malunited - surgery
Humans
Magnetic Resonance Imaging
Male
Middle Aged
Osteotomy - methods
Postoperative Complications - diagnosis
Postoperative Complications - surgery
Radiography
Reoperation
Tibial Fractures - diagnostic imaging
Tibial Fractures - surgery
Torsion Abnormality
title Correcting torsion after intramedullary nailing osteosynthesis of the lower extremity
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