![]() ![]() Therefore, the aim of this retrospective study was to report and describe a novel technique for measurement of fractures in the femoral neck plane to reliably and objectively display the torsional error that has remained after osteosynthesis. In femoral neck fractures, the pointer function of the femoral neck, which is absolutely essential for this technique, is lost and cannot be set in relation to the condylar plane. A widely used technique was reported by Jarrett et al.ĭue to this method being validated for fractures distal to the femoral neck and proximal to the femoral condyles, the application of this method in fractures proximal to the trochanter plane is not reported in literature.Ĭloser inspection of the anatomic landmarks of the femoral neck reveals that this method and any other reported method for the assessment of a shaft malrotation in the femur may not work. ![]() Īs for postoperative diagnosis of malrotation, CT is the method of choice, although several methods of measuring are reported. In literature, many suggestions are made without considering the impact of the general incidence of malrotation. While postoperative diagnosis of malrotation in adults is usually done by computed tomography (CT), intraoperative detection of malrotation in long bone fractures is difficult. While the general incidence of hip fractures is increasing because of demographic changes, the number of high energy fractures in young patients is not affected. However, everyday clinical practice in a level I trauma center shows that postoperative maltorsion after internal fixation of femoral neck fractures can have a significant impact on mobilization and outcome. The reported high rate of avascular necrosis, nonunion, malunion, and implant failure in young patients as well as the common practice of providing joint replacement for older patients may be the reason for the rare reporting of this complication after osteosynthesis in case of a fractured femoral neck. In elderly patients, for displaced femoral neck fractures the treatment of choice is the arthroplasty however, for younger patients (<50 years), open reduction and internal fixation is considered the gold standard approach, although there is no consensus on the preferred specific procedure (cannulated screw fixation vs. To the best of our knowledge, torsional malalignment after femoral neck fractures has not been previously described. Most often, the malrotation occurs in the shaft of the femur but is also a problem in patients with proximal femoral and femoral neck fractures. įollowing literature recommendation, differences up to 15° malrotation needs no corrective intervention s. Upon analyzing 220 femoral shaft fractures treated in our institution, we previously found the incidence of maltorsion>10° to be 43.2% and maltorsion>15° to be 22.7%. The incidence of postoperative maltorsion greater than 10° after femoral nailing is around 41.7%. Torsional malalignment after shaft fractures of long bones is a very well-known clinical complication that can affect both the lower as well as the upper extremity. When it comes to the intraobserver reliability, the measured cohort shows a significant better ICC for the novel method compared to Jarrett et al, with 0.907 respectively 0.786 for comparison in torsional differences. If the examinations are classified according to the patient side, our data show that for established methods, an ICC between the examiners on the right lower extremity is 0.978 (good) (95%CI, 0.936–0.994 p<0.001) and that on the left extremity is 0.955 (good) (95%CI, 0.867–0.988 p<0.001). For torsional difference, the interrater reliability -ICC (interclass correlation) between all investigators was 0.887 (good) (significance level: 95%CI, 0.668–0.969 p<0.001), by using the method of Jarret et al. We applied a new geometric technique, without the need to include the femoral condyles in the measurement, to directly measure the angulation. To determine the intraobserver reliability the torsional angles were calculated again after 3 months. ![]() Three investigators (1 orthopaedic surgeons and 2 radiologists) measured the torsion of 20 legs on 10 patients using the Jarret method and a new geometric technique. ![]()
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