Chandak Orthopaedic Hospital, Government Medical College, Sitaburdi, Nagpur, Maharashtra, 440012, India.
Bharatratna Atal Bihari Vajpayee Medical College, Mangalvar Peth, Pune, Maharashtra, 411011, India.
Eur J Orthop Surg Traumatol. 2024 Aug;34(6):3029-3034. doi: 10.1007/s00590-024-04011-8. Epub 2024 Jun 16.
Femur shaft fractures commonly occur due to high velocity trauma and most of them are fixed with nailing. Malrotation is common after fixation. A rotational malalignment more than 30° is a deformity which requires correction. Various techniques described for rotational deformities are: the 'cable techniques' for the determination of varus-valgus malalignment; the 'hyperextension test', 'radiographic recurvatum sign', 'tibial plateau sign', and 'meterstick technique' for length analysis; and the 'hip rotation test', 'lesser trochanter shape sign', 'cortical step sign', and 'diameter difference sign' for rotational analysis. We describe integration sign at the medial or lateral aspect of notch of femur in fixed internal or external rotation due to condensation of trabeculae.
This is a prospective observational study. Informed consent was taken, and this study was approved by institutional review board. C arm imaging study of 50 knees was done at our institution in which rotational profile of distal femur was analyzed In 3 different views -AP , Internal and external rotation views. The rotation views were taken sequentially and each observer was asked to identify the sign at its appearance and at rotation when it was best seen. All the observers were asked to draw the sign on linear line diagram of distal femur. The data was analysed statistically.
Sign of integral (∫) for rotational deformity was seen at Mean external rotation of 22±1.71 with a range of 19 degree to 25 degree and Mean internal rotation of 15.78±1.21 with a range of 14 degree to 18 degree.
The integration sign can be used as intraoperative C arm sign to understand the rotational deformity of distal fragment of femur. This helps the surgeon to understand the alignment and revise if needed intraoperatively. If combined with position of lesser trochanter, this will give alignment for both proximal as well as distal fragment of femur.
股骨干骨折通常由高速创伤引起，大多数采用钉固定。固定后常发生旋转畸形。旋转对线超过 30°是一种需要矫正的畸形。描述的各种技术用于旋转畸形：“电缆技术”用于确定内翻-外翻对线不良；“过伸试验”、“放射状后凸征”、“胫骨平台征”和“米尺技术”用于长度分析；“髋关节旋转试验”、“小转子形状征”、“皮质台阶征”和“直径差征”用于旋转分析。我们描述了在固定的内旋或外旋时，由于小梁的凝聚，在股骨切迹的内侧或外侧出现的综合征。
这是一项前瞻性观察研究。征得知情同意，并获得机构审查委员会的批准。在我们的机构进行了 50 例膝关节的 C 臂影像学研究，在 3 种不同的视图（前后位、内旋和外旋位）下分析了股骨远端的旋转形态。旋转视图依次拍摄，每个观察者都被要求在出现时识别该征，并在最佳观察时识别该征。所有观察者都被要求在线性股骨远端图上绘制该征。对数据进行统计学分析。
旋转畸形的积分（∫）征在平均外旋 22°±1.71 时出现，范围为 19°至 25°，平均内旋 15.78°±1.21，范围为 14°至 18°。
积分征可作为术中 C 臂征，了解股骨远端旋转畸形。这有助于外科医生理解对线，并在术中进行修正。如果与小转子的位置相结合，将为股骨近端和远端提供对线。
