Trauma Department, Hannover Medical School, Carl-Neuberg-Str. 1, 30655 Hannover, Germany.
Arch Orthop Trauma Surg. 2012 May;132(5):613-6. doi: 10.1007/s00402-011-1450-y. Epub 2011 Dec 27.
Rotational malalignment after intramedullary nailing of femoral fractures remains an unresolved problem. Various techniques have been described to address this problem, with limited success. In this cadaveric study, we describe the determination of the femoral anteversion (FAV) angle utilizing a new imaging software program which allows us to generate and manipulate reformatted virtual images from standard DICOM (Digital Imaging and Communications in Medicine) images.
Eleven intact femoral specimens were scanned by CT before and after fracture induction in standardized fashion. The obtained DICOM image datasets were uploaded to the new software tool. From this, we obtained reformatted virtual fracture fragment images, which enabled us to reconstruct the femoral anatomy and determine FAV measurements. We then compared FAV measurements before and after fracture induction to determine if there were any statistically significant differences.
Fracture induction generated 5 AO type A and 6 AO type B fractures. In the specimens prior to fracture induction, we were able to determine the mean FAV to be 17.94° ± 4.48°. Additionally, analysis of the fractured femoral specimens revealed the new mean FAV to be 16.26° ± 4.83°. Statistical analysis of these two measurement groups did not demonstrate statistical significance. When a sub-analysis was performed of the FAV measurements between the two different AO fracture types, there also were no statistically significant differences.
Through new imaging software that allows us to reformat standard DICOM images and generate virtual fracture fragments, we were able to determine the appropriate FAV. We feel that this technique can potentially be integrated into the imaging algorithm for femoral shaft fractures in the future, and can potentially optimize clinical outcomes by allowing the orthopaedic surgeon to determine precisely the appropriate native FAV.
股骨髓内钉固定后旋转对线不良仍然是一个未解决的问题。已经描述了各种技术来解决这个问题，但成功率有限。在这项尸体研究中，我们描述了使用新的成像软件程序确定股骨前倾角（FAV）的方法，该程序允许我们从标准 DICOM（医学数字成像和通信）图像生成和操作重新格式化的虚拟图像。
11 个完整的股骨标本在标准化方式下进行 CT 扫描，然后在骨折诱导前后进行扫描。获得的 DICOM 图像数据集被上传到新的软件工具中。由此，我们获得了重新格式化的虚拟骨折碎片图像，这使我们能够重建股骨解剖结构并确定 FAV 测量值。然后，我们比较了骨折诱导前后的 FAV 测量值，以确定是否存在任何统计学上的显著差异。
骨折诱导产生了 5 例 AO 型 A 和 6 例 AO 型 B 骨折。在骨折诱导前的标本中，我们能够确定平均 FAV 为 17.94°±4.48°。此外，对骨折股骨标本的分析显示新的平均 FAV 为 16.26°±4.83°。对这两个测量组的统计分析没有显示出统计学意义。当对两种不同的 AO 骨折类型的 FAV 测量值进行亚分析时，也没有统计学意义。
通过允许我们重新格式化标准 DICOM 图像并生成虚拟骨折碎片的新成像软件，我们能够确定合适的 FAV。我们认为，这种技术将来有可能整合到股骨干骨折的成像算法中，并通过允许骨科医生精确确定合适的原生 FAV，从而有可能优化临床结果。
