Mansouri-Tehrani Mohammad Masih, Yavari Pedram, Moosayii Donya, Eslami Sepehr, Nourian Sayed Mohammad Amin
Student Research Committee, School of Medicine, Shahid Beheshti University of Medical Sciences Tehran, Iran.
Department of Orthopedics, School of Medicine, Isfahan University of Medical Sciences Isfahan, Iran.
Int J Burns Trauma. 2021 Oct 15;11(5):418-423. eCollection 2021.
Intramedullary nailing and closed reduction are one of the most important treatment strategies for femoral shaft fractures. Malrotation in the femoral shaft is a complication that requires exact investigations. Here we aimed to evaluate and report the outcomes of malrotation of femur in patients with femoral shaft fractures following antegrade intramedullary nailing.
In this cross-sectional study, 140 patients who had referred to Shahid-Beheshti Hospital in Abadan, Iran and had undergone antegrade intramedullary fixation for isolated femoral shaft fracture during a 6-year period from 2015 to 2021 were enrolled. Demographic information and disease-related information were collected. During operation, the patients were assessed clinically for malrotation of femur with 90° of the knee flection and with the hip in 0° flexion and then in the postoperative follow-up period, the patient was examined again and a computed tomography scan requested to identify the degree of malrotation of femur and the observers were unaware of the CT scan result at the time of the clinical examination. We also measured the amount of internal and external rotation while the patient in the lying supine position with 90° flexion in the knee and hip joint and lying prone position with hip extension. In CT imaging to determine the amount of malrotation of femur, the angle between a line drawn across the two femoral condyles in the posterior aspect and the femoral neck shows the amount of rotation.
Degree of rotational deformity, less than 5°, 5 to 10° and 10 to 15° was less than 8.6%, 75.7% and 15.7% respectively and did not relate to age, sex, fracture location and activity of the patients (P>0.05). There was a strong linear correlation with the average predictive power between clinically detected torsional deformity in comparison with the CT detected torsional deformity (r=0.333 and P=0.005), which was stronger in women than men (r=0.336 in men and r=0.659 in women) (P<0.05). There was a strong linear correlation with the average predictive power between clinically detected torsional deformity in comparison with the CT detected torsional deformity was observed only in external malrotation of femur (r=0.541 and P=0.001). A poor inverse linear relationship was observed between clinically detected and CT detected torsional deformity with the age of the patients which the correlation of clinically detected was more than the CT detected (r in clinical examination =-0.285 and r in CT measurement =-0.246) (P<0.05).
In this study, there was no femoral malrotation over 15° that was associated with clinical symptoms. However, a CT scan should be performed for accurate diagnosis and necessary measures but it does not seem necessary to perform in all patients.
髓内钉固定和闭合复位是股骨干骨折最重要的治疗策略之一。股骨干旋转不良是一种需要精确检查的并发症。在此，我们旨在评估并报告顺行髓内钉固定治疗股骨干骨折患者股骨旋转不良的结果。
在这项横断面研究中，纳入了2015年至2021年期间转诊至伊朗阿巴丹的沙希德 - 贝赫什提医院并接受孤立股骨干骨折顺行髓内固定治疗的140例患者。收集了人口统计学信息和疾病相关信息。手术过程中，在膝关节屈曲90°且髋关节屈曲0°时对患者进行股骨旋转不良的临床评估，术后随访期间再次对患者进行检查，并要求进行计算机断层扫描以确定股骨旋转不良的程度，临床检查时观察者不知道CT扫描结果。我们还测量了患者仰卧位膝关节和髋关节屈曲90°以及俯卧位髋关节伸展时的内旋和外旋量。在CT成像中确定股骨旋转不良的量时，在股骨后侧横跨两个髁绘制的线与股骨颈之间的角度显示旋转量。
旋转畸形程度小于5°、5至10°和10至15°的分别少于8.6%、75.7%和15.7%，且与患者的年龄、性别、骨折部位和活动情况无关（P>0.05）。与CT检测到的扭转畸形相比，临床检测到的扭转畸形之间存在较强的线性相关性，平均预测能力较强（r = 0.333，P = 0.005），女性比男性更强（男性r = 0.336，女性r = 0.659）（P<0.05）。仅在股骨外旋时观察到与CT检测到的扭转畸形相比，临床检测到的扭转畸形之间存在较强的线性相关性，平均预测能力较强（r = 0.541，P = 0.001）。观察到临床检测和CT检测到的扭转畸形与患者年龄之间存在不良的负线性关系，临床检测的相关性大于CT检测的相关性（临床检查中r = -0.285，CT测量中r = -0.246）（P<0.05）。
在本研究中，未发现超过15°的股骨旋转不良与临床症状相关。然而，应进行CT扫描以进行准确诊断并采取必要措施，但似乎并非对所有患者都有必要进行。
