Document Detail


Femoral fracture malrotation caused by freehand versus navigated distal interlocking.
MedLine Citation:
PMID:  17888433     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVES: Rotational deformity following intramedullary nailing of femoral shaft fractures is a clinically significant and underdiagnosed problem. Intraoperative determination of rotation is difficult and may be caused by several factors. The insertion of interlocking screws at a slightly oblique angle may cause a substantial degree of rotational deformity, and this factor has not been evaluated as a cause of malrotation. METHODS: In eight paired cadaveric femurs, a midshaft transverse fracture was created and an antegrade nail was placed. The specimens were placed in a custom jig which allowed free rotation of the distal segment. Distal interlocking was performed using either a freehand technique or with navigation, and femoral anteversion was measured before and after interlocking to determine the change caused by the interlocking screw. RESULTS: Freehand placement led to rotational shift up to 7 degrees (mean, 5.8 degrees ; range, 4-7 degrees ), and navigated insertion led to a change of 2.0 degrees (range, 1-3 degrees ; p<0.05). In addition, drill-nail contact and a visible shift of the fracture site occurred in all freehand trials, whereas in the navigation group, contact occurred in only one trial without fracture movement. CONCLUSIONS: Freehand distal interlocking may be a substantial cause of rotational deformity, and the assistance of computer navigation systems may improve this malrotation.
Authors:
Michael J Gardner; Musa Citak; Daniel Kendoff; Christian Krettek; Tobias Hüfner
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Publication Detail:
Type:  Journal Article     Date:  2007-09-20
Journal Detail:
Title:  Injury     Volume:  39     ISSN:  0020-1383     ISO Abbreviation:  Injury     Publication Date:  2008 Feb 
Date Detail:
Created Date:  2008-02-06     Completed Date:  2008-08-18     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0226040     Medline TA:  Injury     Country:  Netherlands    
Other Details:
Languages:  eng     Pagination:  176-80     Citation Subset:  IM    
Affiliation:
Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY 10021, USA. michaelgardnermd@gmail.com
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MeSH Terms
Descriptor/Qualifier:
Bone Nails*
Cadaver
Femoral Fractures / surgery*
Fluoroscopy
Fracture Fixation, Intramedullary / methods*
Humans
Surgery, Computer-Assisted / methods
Torsion Abnormality / etiology*,  prevention & control

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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