Determination of Sagittal Alignment Measurements in Distal Femurs

Abstract

The necessity for reliability and quality of intraoperative and postoperative radiographic controls of the obtained fracture reduction, implant insertion, and final healed fracture increases with popularity of less invasive indirect reduction and stabilization methods. The ability to obtain exact sagittal alignment measurements has been problematic with other studies. Two different and reliable methods of measuring sagittal plane anatomy and measurements independent of implants were confirmed using plain radiographic images.

Measurement of three‐dimensional morphological characteristics of the calcaneus using CT image post‐processing

“…With the development of computer science, basic theories and methods for CT post-processing and image processing algorithms are widely used. Many software platforms can also perform accurate 3D measurements on a patient’s anatomy [ 12 , 14 , 34 ]. Gutekunst et al developed the methods to define bone axes using landmarks on quantitative CT bone surface meshes to assess 3D foot bone-to-bone orientation angles, which presented the angular measurement with moderate to high ICC values and high precision [ 12 ].…”

External Fixator–Assisted Reduction of Distal Femur Fractures: A Technical Trick

“…Mechanical malalignment in distal femur fractures continues to be an issue during lateral distal femoral locking plate application, thereby hindering bony union. 5,10,16 Coronal plane malreductions consisting of valgus and translational ("golf club") components are an issue when using the lateral distal femur locking plate. Several methods have been described to control coronal plane reduction including meticulous interpretation of radiographic imaging, intraoperative fluoroscopic imaging of the contralateral limb for comparison, using the opaque electrocautery cord to evaluate coronal alignment, and matching an outline of the anteroposterior view of the contralateral distal femur on the fluoroscopic image intensifier.…”

“…In addition, sagittal plane malreduction can affect the knee's arc of motion and the gait cycle. 5,10 Recurvatum or extension deformity is more common because the femoral condyles are displaced by the pull of the gastrocnemius muscles. Techniques to restore sagittal plane deformity include contralateral fluoroscopic images for comparison, correct sagittal plane plate placement on the distal lateral femoral condyle, and techniques for measuring sagittal alignment using intraoperative radiographic landmarks.…”

“…Techniques to restore sagittal plane deformity include contralateral fluoroscopic images for comparison, correct sagittal plane plate placement on the distal lateral femoral condyle, and techniques for measuring sagittal alignment using intraoperative radiographic landmarks. 5,10 Rotational malalignment, specifically external rotation, creates gait cycle abnormalities and problems with activities. 18,19 Several intraoperative fluoroscopic techniques have been developed to help judge rotational deformity including the true lateral technique, neck horizontal angle technique, and the lesser trochanter profile technique.…”

“…2F). In cases with significant metaphyseal comminution such as this one, alignment was confirmed with an intraoperative long cassette radiograph (see Because of patient's previous surgery, preinjury distal femoral radiographs were used to measure the anatomic lateral distal femoral angle (aLDFA), and the sagittal alignment was measured, according to the technique by Hoffman et al 10 maxima posteriorly and the proximal rim of the articular surface on the condyle. Preoperatively, the aLDFA was 87 degrees, and the sagittal alignment was 88 degrees (Fig.…”