Torsional Deformities Following Intramedullary Nailing of Femur and Tibia Fractures

Diaphyseal fractures of femora and tibiae in adults are generally stabilised by intramedullary nailing. Nevertheless, this proven technique is burdened by a lack of torsional control intraoperatively. The aim of the study was therefore to analyse the clinical importance of torsional deviations after intramedullary nailing. 180 non-selected patients with diaphyseal fractures according to the A0 classifications 32 (n = 80) and 42 (n = 100) were enrolled in a prospective study. Additionally, the fracture type according to Winquist was defined as well as the soft tissue damage. All fractures were stabilised by locked intramedullary nailing. All patients underwent a torsional analysis by CT or ultrasound after complete fracture healing. In femora an external torsional malalignment of 10-15° was detected in 10 %, of 15-20° in 8.8 % and of more than 20° in 16.3 %. An internal torsional malalignment of 10-15° was noticed in 5 % and of 15-20° in 2.5 %. The healthy contralateral femur served in all cases as intra-individual reference. In the nailed tibiae, external torsional deviations of 10-15° occurred in 10 %, of 15-20° in 2 % and of more than 20° in 4 %. Internal torsional deviations of 10-15° were seen in 5 %, of 15-20° in 3 % and of more than 20° in 1 % of all patients. Torsional deviations of more than 15° concern 28 % of all nailed femora and more than 10 % of all tibiae. Torsional malalignment after intramedullary nailing of the lower limb is of great clinical importance. However, intraoperative torsional control has to be improved.