Sathy Ashoke, Barnwell Jonathan C, Shahrestani Sean N, Moore Daniel
Departments of *Orthopaedic Surgery, and†Radiology, University of Texas Southwestern Medical Center, Dallas, TX.
J Orthop Trauma. 2017 Apr;31(4):e121-e126. doi: 10.1097/BOT.0000000000000767.
To evaluate a previously described technique using the inherent anteversion of intramedullary nail (IMN) to avoid malrotation in comminuted femur fractures and describe the use of magnetic resonance imaging (MRI) as an alternative method for assessing postoperative femoral version.
Prospective consecutive cohort study.
Level I trauma center.
PATIENT/PARTICIPANTS: Twenty-five consecutive patients with comminuted femur fractures (Winquist III/IV, OTA/AO 32-B/32-C) treated by a single surgeon with IMN between September 1, 2011, and February 28, 2015.
IMN on a fracture table with intraoperative femoral version set by the inherent version of the implant. All patients received a postoperative computed tomography (CT) or MRI to assess femoral version.
Mean difference in postoperative femoral anteversion (DFA) between injured limb and uninjured limb as measured by CT or MRI. Mean difference in postoperative femoral version of the injured femur from the inherent version of the implant (12 degrees) was measured with CT or MRI.
The mean postoperative DFA was 9.1 ± 5.6 degrees. Postoperative DFA greater than 15 degrees was found in 2 (8.0%) patients. Mean difference in postoperative version of the injured femur from the inherent 12 degrees of the implant was 7.1 ± 5.4 degrees. Patients tolerated MRI studies well.
Our previously described technique using the inherent anteversion of an IMN is effective and leads to a very low rate of malrotation, even in highly comminuted fractures. The technique is particularly useful in treating bilateral femur fractures. MRI can be used safely and effectively to assess anteversion after fixation of femur fractures.
Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
评估一种先前描述的利用髓内钉（IMN）固有前倾角度来避免粉碎性股骨骨折发生旋转不良的技术，并描述使用磁共振成像（MRI）作为评估术后股骨扭转角度的替代方法。
前瞻性连续队列研究。
一级创伤中心。
患者/参与者：2011年9月1日至2015年2月28日期间，由同一位外科医生使用IMN治疗的25例连续的粉碎性股骨骨折患者（Winquist III/IV型，OTA/AO 32 - B/32 - C型）。
在骨折手术台上使用IMN，术中通过植入物的固有角度设置股骨扭转角度。所有患者术后均接受计算机断层扫描（CT）或MRI以评估股骨扭转角度。
通过CT或MRI测量患侧肢体与未受伤肢体术后股骨前倾角度（DFA）的平均差异。通过CT或MRI测量受伤股骨术后扭转角度与植入物固有角度（12度）的平均差异。
术后DFA的平均值为9.1±5.6度。2例（8.0%）患者术后DFA大于15度。受伤股骨术后扭转角度与植入物固有12度的平均差异为7.1±5.4度。患者对MRI检查耐受性良好。
我们先前描述的利用IMN固有前倾角度的技术是有效的，即使在高度粉碎性骨折中，旋转不良率也非常低。该技术在治疗双侧股骨骨折时特别有用。MRI可安全有效地用于评估股骨骨折固定后的前倾角度。
治疗性四级证据。有关证据水平的完整描述，请参阅作者指南。
