A technique to obtain correct rotational alignment during closed locked intramedullary nailing of the femur

Retrograde nailing of femoral fractures: a retrospective study

“…Some authors have reported rotational malalignment after intramedullary nail to be as high as 28 %, often leading to a cosmetic and functional disability [16,17]. A surgeon must be especially careful to prevent malrotation, as further operation is the only way to correct the deformity once the screw is locked [17].…”

“…Some authors have reported rotational malalignment after intramedullary nail to be as high as 28 %, often leading to a cosmetic and functional disability [16,17]. A surgeon must be especially careful to prevent malrotation, as further operation is the only way to correct the deformity once the screw is locked [17]. Braten et al [18] described one method to prevent malrotation intraoperatively by using intraoperative fluoroscopy to measure the neck-horizontal (NH) and neck-femoral (NF) angles.…”

The Cortical Step Sign Fails to Prevent Malrotation of a Nailed Femoral Shaft Fracture: A Case Report

“…CT axial cuts revealed a 15° external rotation deformity of the operative extremity, while the accompanying CT AP scout image reveals no CSS. Assessing femoral rotation based purely on clinical exam such as matching the soft tissue tension and skin fold geometry to that of the unaffected limb has been associated with a higher rate of malrotation 12.46° (range 6.4°–17.7°), when compared with using a fluoroscopy assisted technique 4.1° (range 0°–9.9°) [6]. Thus various fluoroscopic techniques have been described to help correct intraoperative femoral malrotation.…”

Limb Malalignment and Functional Outcome After Antegrade Versus Retrograde Intramedullary Nailing in Distal Femoral Fractures

“…[23][24][25][26][27][28] After analysis of several studies, most authors stated a better control of femoral torsion as an advantage of retrograde nailing. 3,14,18,21,29,30 Tornetta and Tiburzi challenged these findings and postulated a better length and rotational control by antegrade nailing as a result of the use of fracture tables. 22 The current study provides information about the functional results, shortening, and malalignment after nailing of the common, not sufficiently studied, distal femoral fractures.…”

“…3,14,18,21,29,30 Similarly, no nailing was done on a fracture table, therefore the cited advantage of its use by Tornetta and Tiburzi 22 could not be controlled. It seems that the proper operative indication, the intraoperative control, and the surgeon's experience are more important in this regard than the nailing technique.…”