Femoral malrotation following intramedullary nailing in 70 patients

Rotational deformity after intramedullary nailing is a well-known complication. Femoral malrotation is the most common form of malunion but it is underrecognized in part because of the difficulty in accurately assessing rotation as well as the variation that exists in normal anatomy. The aim of this study was to evaluate femoral malrotation following intramedullary nailing of the femur. We studied 70 patients who had referred to Imam Khomeini Hospital and had undergone antegrade intramedullary fixation for isolated femoral shaft fracture during 3-year period from 2008 to 2011. Inclusion criteria including isolated femoral shaft fracture that had undergone antegrade intramedullary nailing. Exclusion criteria including spontaneous ipsilateral tibial fracture or pelvic fracture، contralateral femoral fracture، femoral fracture that had fixed using plate or external fixator or retrograde intramedullary nailing. During operation، the patients were assessed clinically for rotational deformity and then in the postoperative follow-up period، degree of rotation was identified with CT scan. Postoperative computed tomography measurements of rotation were compared with the opposite side. There were 70 patients، 56 men and 14 women. The average age of the patients was 28. 21±14. 39 patients (55/7%) had external rotation and 31 patients (44/3%) had internal rotation. The mean of malrotation degree in physical examination was 4/67 and The mean of malrotation degree in CT scan was 7. Degree of malrotation deformity، less of 5º، 5 to 10º and 10 to 15º was less of 8. 6%، 75. 7% and 15. 7% respectively. Degree of malrotation didn’t relate to age، sex، fracture location and activity of the patients (P> 0. 05). Rotational deformity in 28% of the patients was equal to more 15º. This complication didn’t relate to fracture location. The patients with external rotation deformity had more symptoms than the patients with internal rotational deformity but there isn’t significant relation in this study.