Department of Orthopaedic Surgery, Flinders Medical Centre, Adelaide, Australia.
Department of Orthopaedic Surgery, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands.
J Orthop Trauma. 2024 Jun 1;38(6):e207-e213. doi: 10.1097/BOT.0000000000002797.
Intramedullary nailing is the treatment of choice for most tibial shaft fractures (TSF). However, an iatrogenic pitfall may be rotational malalignment. The aim of this retrospective analysis was to determine predictors of rotational malalignment following intramedullary nailing of TSF.
Retrospective study.
Single level 1 trauma center.
Patients who had a unilateral intramedullary nailing for TSF with a low-dose bilateral postoperative CT to assess rotational malalignment.
Bivariable analysis followed by multivariable analysis was then undertaken to assess for any independent predictors, such as fracture type/sight, surgeon experience, and side of fracture, predictive of rotational malalignment.
In total, 154 patients (71% male, median age 37 years) were included in this study. Thirty-nine percent of variability in postoperative rotational malalignment could be explained using a model including (increased) tibial torsion of the noninjured side (mean [38.9 degrees ± 9.02 degrees] considered normal tibial torsion), side of tibial fracture, and spiral-type tibial fracture (R2 = 0.39, P ≤ 0.001, F = 31.40). In this model, there was a negative linear association between degrees of torsion on the noninjured side and rotational malalignment (-0.45, P < 0.001)-as baseline torsion increased from mean by 1 degree, malrotation in the opposite direction of 0.54 degrees seen. Positive linear associations between right-sided TSF and rotational malalignment (8.59 P < 0.001) as well as spiral fractures and rotational malalignment (5.03, P < 0.01) were seen.
This study demonstrates that baseline reduced (internal) tibial torsion of the noninjured limb, spiral fractures, and right-sided TSF are predictive of postoperative external rotational malalignment. Conversely, increased baseline (external) tibial torsion of the noninjured limb and left-sided TSF are predictive of postoperative internal rotational malalignment. Surgeons may use this regression model preoperatively to predict what sort of postoperative rotational difference their patient may be prone to.
Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.
髓内钉是治疗大多数胫骨骨干骨折（TSF）的首选方法。然而，医源性陷阱可能是旋转对线不良。本回顾性分析的目的是确定髓内钉治疗 TSF 后发生旋转对线不良的预测因素。
回顾性研究。
一级创伤中心。
接受单侧髓内钉治疗 TSF 并接受低剂量双侧术后 CT 以评估旋转对线不良的患者。
然后进行单变量和多变量分析，以评估任何独立的预测因素，如骨折类型/视力、外科医生经验和骨折侧，这些因素可能与旋转对线不良有关。
本研究共纳入 154 例患者（71%为男性，中位年龄 37 岁）。使用包括（增加的）健侧胫骨扭转、胫骨骨折侧和螺旋型胫骨骨折的模型，可以解释术后旋转对线不良的 39%的变异性（未受伤侧的平均[38.9 度±9.02 度]被认为是正常的胫骨扭转）（R2=0.39，P≤0.001，F=31.40）。在该模型中，健侧扭转角度与旋转对线不良之间存在负线性关系（-0.45，P<0.001）-随着基线扭转角度比平均值增加 1 度，观察到相反方向的旋转 0.54 度。右侧 TSF 与旋转对线不良（8.59，P<0.001）以及螺旋骨折与旋转对线不良（5.03，P<0.01）之间存在正线性关系。
本研究表明，健侧肢体基线降低（内侧）胫骨扭转、螺旋骨折和右侧 TSF 是术后外旋对线不良的预测因素。相反，健侧肢体基线增加（外侧）胫骨扭转和左侧 TSF 是术后内旋对线不良的预测因素。外科医生可以在术前使用该回归模型预测患者可能容易出现哪种术后旋转差异。
预后 III 级。请参阅作者说明以获取完整的证据水平描述。
