Malrotation following reamed intramedullary nailing of closed tibial fractures

Abstract

Background:Rotational malalignment after intramedullary tibial nailing is rarely addressed in clinical studies. Malrotation (especially >10°)of the lower extremity can lead to development and progression of degenerative changes in knee and ankle joints. The purpose of this study is to determine the incidence and severity of tibial malrotation after reamed intramedullary nailing for closed diaphyseal tibial fractures.Materials and Methods:Sixty patients (53 males and 7 females) with tibial diaphyseal fracture were included in this study. The mean age of the patients was 33.4±13.3 years. All fractures were manually reduced and fixed using reamed intramedullary nailing. A standard method using bilateral limited computerized tomography was used to measure the tibial torsion. A difference greater than 10° between two tibiae was defined as malrotation.Results:Eighteen (30%) patients had malrotation of more than 10°. Malrotation was greater than 15° in seven cases. Good or excellent rotational reduction was achieved in 70% of the patients. There was no statistically significant relation between AO tibial fracture classification and fibular fixation and malrotation of greater than 10°.Conclusions:Considering the high incidence rate of tibial malrotation following intramedullary nailing, we need a precise method to evaluate the torsion intraoperatively to prevent the problem.

Findings related to rotational malalignment in tibial fractures treated with reamed intramedullary nailing

“…In contrast to the low rates of malrotation determined by clinical measurements, in studies which measured radiologically with CT, Prasad et al [15] determined malrotation at a rate of 36 % in 22 patients, Puloski et al [2] at 22 % in 22 patients, Jafarinejad et al [24] at 30 % in 60 patients, and Theriault et al [30] at 41 % in 70 patients. In the current study, malrotation was determined in five (19 %) of 26 patients with CT. A rotational difference of more than 108 was determined in two of these five patients with the clinical measurement of TFA.…”

“…Positive values were evaluated as external malrotation and negative values as internal malrotation. As has been accepted in previous studies on malrotation in literature, more than 108 between the two extremities was accepted as a rotational difference [2,16,24,30].…”

“…Generally, more than 1 cm shortness and more than 58 rotational or angular deformity are accepted as malunion [29]. In most of the studies malrotation was defined to be greater than 10° [2,16,24,30]. Tibial malrotation findings are minimal and usually patients have no clinical sign of tibial malrotation.…”

Application of the multiplanar fracture redactor in the treatment of tibial shaft fractures with intramedullary nails

“…Malalignment is a common complication for patients with tibial shaft fractures treated by IMN, which has been reported to account for 19% to 41% of cases 18 , 30 , 31 . Patients with postoperative malalignment are likely to have a compromised functional outcome 32 .…”

Radiographic cortical thickness parameters as predictors of rotational alignment in proximal tibial shaft fractures: a cadaveric study

“…Despite its advantages and widespread use, tibial nailing remains a technically challenging procedure. Postoperative, clinically-significant tibial maltorsion described as a torsional difference of 15 degrees or more between the main proximal and distal fragments, occurs in between 19 and 41% of cases [ 4 , 6 – 9 ].…”