Tibial Malrotation Following Intramedullary Nailing: A Literature Review

Fernandes, A; Sagoo, K. S.; Oluku, Jennifer; Cheema, Kamalpreet S

doi:10.7759/cureus.19683

Cited by 4 publications

(7 citation statements)

References 10 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…3D planning based on sectional images and customized templates proved to lead to more precise results than today’s free‐hand gold standard [8, 17, 26, 29]. Overall, it might reduce malunion and/or revision surgery in comminuted diaphyseal lower extremity fractures by 30–50% [4, 6, 7, 10].…”

Section: Discussionmentioning

confidence: 99%

“…Considering the frequent malalignment in complex fractures, the aim of patient management should be to ‘Get It Right First Time’ [7]. 3D planning based on sectional images and customized templates proved to lead to more precise results than today’s free‐hand gold standard [8, 17, 26, 29].…”

Section: Discussionmentioning

confidence: 99%

“…In femoral fractures, rotational errors occur in up to 40% of cases after surgical treatment, which either results in a poor clinical outcome or requires revision surgery [6, 10]. In tibial diaphyseal fractures, up to 50% rotational errors have been reported [4, 7]. The higher the degree of comminution the higher are the chances of malrotation postoperatively.…”

Section: Introductionmentioning

confidence: 99%

“…The higher the degree of comminution the higher are the chances of malrotation postoperatively. The reason is, that due to the comminuted situation, no reliable bony references exist intraoperatively and the surgeon can only estimate the correct length, rotation, and coronal/sagittal alignment based on the contralateral leg [7].…”

Section: Introductionmentioning

confidence: 99%

“…The exact definition of a malrotated femur or tibia remains controversial. Tolerances range between 10 and 30° in the femur [1, 2, 6] and 10–25° in the tibia [7, 25]. It was shown that femoral rotational malalignment compared to the contralateral side of ≥10° was likely to be symptomatic and that hip, knee, and patellofemoral joints were affected [15].…”

Section: Introductionmentioning

confidence: 99%

See 4 more Smart Citations

3D printed fracture reduction guides planned and printed at the point of care show high accuracy – a porcine feasibility study

Hecker

Eberlein

2022

J EXP ORTOP

View full text Add to dashboard Cite

Purpose After surgical treatment of comminuted diaphyseal femoral and tibial fractures, relevant malalignment, especially rotational errors occur in up to 40–50%. This either results in a poor clinical outcome or requires revision surgery. This study aims to evaluate the accuracy of reduction if surgery is supported by 3D guides planned and printed at the point of care. Methods Ten porcine legs underwent computed tomography (CT) and 3D models of femur and tibia were built. Reduction guides were virtually constructed and fitted to the proximal and distal metaphysis. The guides were 3D printed using medically approved resin. Femoral and tibial comminuted diaphyseal fractures were simulated and subsequently reduced using the 3D guides. Postoperative 3D bone models were reconstructed to compare the accuracy to the preoperative planning. Results Femoral reduction showed a mean deviation ± SD from the plan of 1.0 mm ± 0.9 mm for length, 0.9° ± 0.7° for varus/valgus, 1.2° ± 0.9° for procurvatum/recurvatum and 2.0° ± 1.7° for rotation. Analysis of the tibial reduction revealed a mean deviation ± SD of 2.4 mm ± 1.6 mm for length, 1.0° ± 0.6° for varus/valgus, 1.3° ± 1.4° for procurvatum/recurvatum and 2.9° ± 2.2° for rotation. Conclusions This study shows high accuracy of reduction with 3D guides planned and printed at the point of care. Applied to a clinical setting, this technique has the potential to avoid malreduction and consecutive revision surgery in comminuted diaphyseal fractures. Level of Evidence Basic Science.

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

3D printed fracture reduction guides planned and printed at the point of care show high accuracy – a porcine feasibility study

Hecker

Eberlein

2022

J EXP ORTOP

View full text Add to dashboard Cite

show abstract

Risk factors for malalignment after intramedullary nail treatment of distal tibia fractures with associated fibula fractures

Chaudhry,

Gutierrez-Naranjo,

Raad

et al. 2024

Eur J Orthop Surg Traumatol

View full text Add to dashboard Cite

Purpose Malalignment of distal tibia fractures can lead to malunion/nonunion or alter the limb mechanical axis which may cause arthritis. Proposed methods to decrease malalignment include fibular fixation or multiplanar interlocking screws, however these remain controversial. This study aimed to identify factors associated with malalignment in distal tibial fractures with associated fibular shaft fractures. Methods A retrospective review was performed of distal tibia fractures with associated fibular shaft fractures treated with intramedullary nailing at two level one trauma centers between 2015 and 2019. Cases involving malalignment (> 5° of deviation from anatomic axis on either coronal/sagittal axis) on final follow-up (minimum three months postoperatively) were compared to those without malalignment with regard to demographics, fracture characteristics, intraoperative characteristics, and complications. Results The rate of malalignment was 13%. On multivariate analysis, multiplanar distal interlocking screw fixation (odds ratio [OR], 0.18; 95% confidence interval [CI] 0.03–0.92) was associated with a decreased rate of final malalignment, while nail diameter > 10 mm was associated with a higher rate (OR, 4.05; 95% CI 1.25–13.11). Fibular fixation was not associated with malalignment. Conclusion Multiplanar distal interlocking screws may protect against malalignment. Fibula fixation does not appear associated with a decreased rate of malalignment in distal tibia fractures treated with intramedullary nails. Level of Evidence III.

show abstract

Minimally Invasive Osteotomy for Correction of Post-Traumatic Tibia Internal Rotation Deformity: A Case Report

Gupta,

Negi,

Thami

et al. 2024

jocr

View full text Add to dashboard Cite

Introduction: Intramedullary nailing is a commonly performed surgery for tibia diaphysis fractures. However, in selected cases, this procedure can get complicated with rotational malalignment if not checked carefully intra-operatively. Case Report: A 29 year-old male sustained polytrauma and was treated with intramedullary nailing for bilateral femur and right-side tibia fractures. Postoperatively, the patient noticed extreme in-toeing suggesting an internal rotation deformity, which caused great difficulty in walking. The patient was planned for a revision surgery to correct the internal rotation deformity, 6 months after the index surgery. A minimally invasive metaphyseal osteotomy was performed, away from his fracture site by drilling multiple holes. The distal locking bolts of the interlocking nail were removed, and two K wires used to achieve the desired correction angle. After rotating the distal fragment, locking bolts were reinserted in new holes. We kept the patient on our regular follow-up till he achieved sound union at the osteotomy site, after which we allowed him unrestricted activities. Conclusion: The presence of an intramedullary nail can hence help the surgeon in correcting such isolated rotational deformities without getting into the hassle of implant removal to achieve the same. Keywords: Minimally invasive osteotomy, tibia malrotation deformity, polytrauma.

show abstract

Tibial Malrotation Following Intramedullary Nailing: A Literature Review

Cited by 4 publications

References 10 publications

3D printed fracture reduction guides planned and printed at the point of care show high accuracy – a porcine feasibility study

3D printed fracture reduction guides planned and printed at the point of care show high accuracy – a porcine feasibility study

Risk factors for malalignment after intramedullary nail treatment of distal tibia fractures with associated fibula fractures

Minimally Invasive Osteotomy for Correction of Post-Traumatic Tibia Internal Rotation Deformity: A Case Report

Contact Info

Product

Resources

About