The torsion of both femora was evaluated in 110 patients who had been treated by intramedullary nailing for unilateral femoral shaft fractures. The anteversion (AV) angle was measured by ultrasound, using a tilted-transducer technique. True torsional deformity, defined as an AV difference of 15#{176} or more between sides was found in 21 patients, but only eight had complaints related to the deformity. Three patients had reoperations for troublesome external torsional deformities. Of 26 patients with AV differences of 100 to 14#{176}, defined as possible torsional deformity, three had complaints, but none had serious problems. AV differences of up to 29#{176} were observed in symptom-free patients, and no patients with AV differences below 100 had complaints. Static and dynamic nailing showed almost equal tendencies to lead to torsional deformity. We conclude that torsional deformities are usually established during the operation. Many patients tolerate abnormal torsion, but efforts should be made to reduce and stabilise the femoral shaft fracture with an AV difference ofless than 15#{176}.

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The results were comparable in most respects. Unprotected weight-bearing was achieved earlier after IM nailing. Anterior knee pain was frequent after nailing.

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The femoral anteversion (AV) angles were measured by ultrasound in a normal group of 100 adult subjects to find the normal range of anteversion, to determine the normal left/right difference, to assess the interobserver variation, and to find the correlation between AV angle and clinical hip rotation. All the ultrasound measurements were performed independently by 2 observers. The mean AV angle was 18 degrees in the women and 14 degrees in the men. The mean left/right difference in AV was 3.8 degrees, and the upper normal limit of side difference (mean +/- 2 SD) was 9.8 degrees. The mean (SD) interobserver variation was only 1.9 degrees (1.3 degrees). The correlations between AV angles and internal and external hip rotation were significant, but not very high (r = 0.49 and -0.49, respectively). We conclude that ultrasound is appropriate for measurement of femoral anteversion. Our results could be used as a basis when evaluating patients with clinically suspected rotational disorders of the femur.