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Yuwen P, Sun W, Guo J, Chang W, Wei N, Wang H, Ding K, Chen W, Zhang Y. Femoral-tibial contact stresses on fixed rotational femur models. Front Surg 2023; 9:1016707. [PMID: 36684303 PMCID: PMC9852333 DOI: 10.3389/fsurg.2022.1016707] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2022] [Accepted: 10/28/2022] [Indexed: 01/09/2023] Open
Abstract
Objectives This study aims to quantitatively evaluate the femoral-tibial contact pressure on the knee under certain malrotaional degrees. Methods Femoral-tibial contact pressure was carried out on 14 fixed rotational knee models under 200/400/600 N vertical load using ultra-low-pressure sensitive film technology, rotation angles including neutral position (0°, anatomically reduced), 5°, 10°, and 15° internally and externally. Data were collected and analyzed with SPSS software. Results There are significant statistical differences between the medial contact pressure among rotational deformities (including neutral position) (P < 0.01), the increase in the degree of fixed internal malrotation of the femur resulted in a linear increase in the medial femoral-tibial contact pressures (P < 0.05) under 200/400/600 N vertical load, while increase in the degree of fixed external malrotation resulted in a linear decrease (P < 0.05). Except the 200 N compression, we can't find significant differences in lateral contact pressures (P > 0.05). In the comparison of medial to lateral contact pressures, no statistically significant differences were found in neutral and 5° internal rotation under 200/400 N, neutral, 5° internal rotation, and 15° external rotation under 600 N. In contrast, medial contact pressures were higher than lateral at other angles (P < 0.05). Conclusion Obvious contact pressure changes were observed in rotatory femur. Doctors should detect rotational deformity as much as possible during operation and perform anatomical reduction. For patients with residual rotational deformities, indication of osteotomy should not be too broad.
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Affiliation(s)
- Peizhi Yuwen
- Orthopaedic Research Institute of Hebei Province, Hebei Medical University Third Affiliated Hospital, Shijiazhuang, China
| | - Weiyi Sun
- Orthopaedic Research Institute of Hebei Province, Hebei Medical University Third Affiliated Hospital, Shijiazhuang, China
| | - Jialiang Guo
- Orthopaedic Research Institute of Hebei Province, Hebei Medical University Third Affiliated Hospital, Shijiazhuang, China
| | - Wenli Chang
- Department of Hand Surgery, Cangzhou Hospital of Integrated TCM-WM of Hebei, Cangzhou, China
| | - Ning Wei
- Department of Orthopedic Surgery, Chinese People's Liberation Army Joint Security Force 980th Hospital, Shijiazhuang, China
| | - Haicheng Wang
- Orthopaedic Research Institute of Hebei Province, Hebei Medical University Third Affiliated Hospital, Shijiazhuang, China
| | - Kai Ding
- Orthopaedic Research Institute of Hebei Province, Hebei Medical University Third Affiliated Hospital, Shijiazhuang, China
| | - Wei Chen
- Orthopaedic Research Institute of Hebei Province, Hebei Medical University Third Affiliated Hospital, Shijiazhuang, China,Key Laboratory of Biomechanics of Hebei Province, the Third Hospital of Hebei Medical University, Shijiazhuang, China,Trauma Emergency Center, the Third Hospital of Hebei Medical University, Shijiazhuang, China,NHC Key Laboratory of Intelligent Orthopeadic Equipment, the Third Hospital of Hebei Medical University, Shijiazhuang, China
| | - Yingze Zhang
- Orthopaedic Research Institute of Hebei Province, Hebei Medical University Third Affiliated Hospital, Shijiazhuang, China,Key Laboratory of Biomechanics of Hebei Province, the Third Hospital of Hebei Medical University, Shijiazhuang, China,Trauma Emergency Center, the Third Hospital of Hebei Medical University, Shijiazhuang, China,NHC Key Laboratory of Intelligent Orthopeadic Equipment, the Third Hospital of Hebei Medical University, Shijiazhuang, China,Correspondence: Yingze Zhang
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Ju B, Moon YJ, Lee KB. Use of Lesser Trochanter Profile as a Rotational Alignment Guide in Intramedullary Nailing for Femoral Shaft Fracture. J Bone Joint Surg Am 2021; 103:e89. [PMID: 34424871 DOI: 10.2106/jbjs.21.00105] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Malrotation after nailing of femoral shaft fractures occurs in about 25% of cases. It can cause substantial functional problems. The lesser trochanter (LT) profile has been used to assess rotational alignment. However, the extent to which the LT profile is symmetrical between limbs, whether the LT profile varies as a function of age or sex, and the efficacy of the LT profile technique remain unknown. The purpose of this study was to determine if there was a significant side-to-side length difference in the LT profile (LTD) according to age and sex. METHODS We attempted to determine the amount of medial prominence of the lesser trochanter relative to the medial cortex of the femoral shaft (the LT profile) using 3-dimensional computed tomography (3D-CT) images of normal femora obtained bilaterally (366 subjects) in anatomic positions. We also compared the left and right sides to determine the amount of natural asymmetry by age and sex. In addition, we compared the side-to-side difference in the LT version with the LTD to determine whether the LTD represented the difference in femoral rotation. RESULTS The LTD was <4 mm (meaning an LT version difference of <10°) in 83% of the subjects, but was ≥4 mm (an LT version difference of ≥10°) in 17%. Subset analysis demonstrated that the differences were greatest in women >70 years of age. The largest LTD (both sexes) was observed in individuals over 70 years of age (2.62 ± 1.37 mm, compared with <55 years: 1.55 ± 1.36 mm and 55 to 70 years: 2.27 ± 1.70 mm). There was no significant difference between sexes in the under-70 age groups. However, the LTD was significantly greater in women over 70 years than in men over 70 years (3.10 ± 1.42 versus 2.41 ± 1.30 mm). CONCLUSIONS Since the LTD demonstrated side-to-side symmetry within 4 mm, or 10° of rotation, in 83% of all subjects, we consider the LT profile to be useful as a guide to assess rotational reduction clinically. However, surgeons should recognize that, in 17% of cases, using this technique could result in malrotation of ≥10°. The rate of malrotation may be even higher in women over 70, for whom supplemental techniques to ensure correct rotation may be appropriate.
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Affiliation(s)
- Baruenchan Ju
- Department of Orthopaedic Surgery, Muju General Hospital, Muju, Republic of Korea
| | - Young Jae Moon
- Department of Orthopaedic Surgery and Biochemistry, Research Institute of Clinical Medicine of Jeonbuk National University-Biomedical Research Institute of Jeonbuk National University Hospital and Research Institute for Endocrine Sciences, Jeonbuk National University Medical School, Jeonju, Republic of Korea
| | - Kwang-Bok Lee
- Department of Orthopaedic Surgery, Research Institute of Clinical Medicine of Jeonbuk National University-Biomedical Research Institute of Jeonbuk National University Hospital, Jeonbuk National University Medical School, Jeonju, Republic of Korea
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Pawik Ł, Pawik M, Wrzosek Z, Fink-Lwow F, Morasiewicz P. Assessment of the quality of life in patients with varying degrees of equalization of lower limb length discrepancy treated with Ilizarov method. J Orthop Surg Res 2021; 16:62. [PMID: 33468173 PMCID: PMC7814564 DOI: 10.1186/s13018-021-02202-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2020] [Accepted: 01/04/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Inequalities in leg length result in functional disorders, as they impair the biomechanics of the musculoskeletal system, significantly reducing the quality of life (QoL). This study used the WHOQoL-BREF questionnaire in patients with varying degrees of lower leg shortness who had undergone treatment by the Ilizarov method, compared to a healthy control group. METHODS Fifty-eight patients treated with the Ilizarov method for discrepancies in lower limb length were grouped by degree of limb equalization (group 1, 37 treated individuals with limb length discrepancy < 1 cm; group 2, 21 individuals with discrepancy ≥ 1 cm but not more than 4 cm). The control group 3 contained 61 healthy individuals. Patient quality of life (QoL) was assessed using a shortened version of the WHOQoL-BREF questionnaire, at least 24 months after the end of Ilizarov therapy. RESULTS Control subjects obtained higher scores in all domains than subjects in both treatment groups, as well as significantly higher self-assessed QoL, and health, in the physical, psychological, social, and general lifestyle domains, as compared to those with inequalities ≥ 1 cm. Furthermore, patients with inequalities ≥ 1 cm had higher odds ratios of low self-assessment (3.28 times; p = 0.043), low self-assessment of health (4. 09 times; p = 0.047), and low physical and psychological domains (respectively 6.23 times; p = 0.005 and 8.46 times, p = 0.049) compared with patients with inequality < 1 cm. The shortened version of the WHOQoL questionnaire was used. CONCLUSIONS After at least 24 months of treatment with the Ilizarov method, patients with limb length discrepancy < 1 cm did not differ significantly from healthy individuals in the WHOQoL self-assessment of mental functioning, social, or life satisfaction.
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Affiliation(s)
- Łukasz Pawik
- Department of Physiotherapy of Motor Disorders and Dysfunctions, University School of Physical Education, al. Paderewskiego 35, 51-612, Wrocław, Poland.
| | - Malwina Pawik
- Health Promotion, Faculty of Physiotherapy, University School of Physical Education, Wrocław, Poland
| | - Zdzisława Wrzosek
- Department of Physiotherapy of Motor Disorders and Dysfunctions, University School of Physical Education, al. Paderewskiego 35, 51-612, Wrocław, Poland
| | - Felicja Fink-Lwow
- Health Promotion, Faculty of Physiotherapy, University School of Physical Education, Wrocław, Poland
| | - Piotr Morasiewicz
- Department of Orthopaedic and Trauma Surgery, University Hospital in Opole, Institute of Medical Sciences, University of Opole, Opole, Poland
- Department and Clinic of Orthopedic and Traumatological Surgery, Wrocław Medical University, Wrocław, Poland
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Morasiewicz P, Konieczny G, Dejnek M, Morasiewicz L, Urbański W, Kulej M, Dragan SŁ, Dragan SF, Pawik Ł. Pedobarographic analysis of body weight distribution on the lower limbs and balance after ankle arthrodesis with Ilizarov fixation and internal fixation. Biomed Eng Online 2018; 17:174. [PMID: 30477523 PMCID: PMC6258158 DOI: 10.1186/s12938-018-0608-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2018] [Accepted: 11/22/2018] [Indexed: 01/23/2023] Open
Abstract
BACKGROUND A number of various techniques were proposed to stabilized ankle arthrodesis, among them external and internal fixation. Appropriate balance and adequate distribution of lower limb loads determine normal biomechanics of the locomotor system. We hypothesized that various techniques used to stabilize ankle arthrodesis may exert different effects on (1) balance and (2) distribution of lower limb loads. METHODS Retrospective analysis included 47 patients who underwent ankle arthrodesis with external stabilization with Ilizarov fixator (group 1, n = 21) or internal stabilization with screws (group 2, n = 26) between 2007 and 2015. Balance and distribution of lower limb loads were determined with a pedobarographic platform. RESULTS In group 1, average load of the operated and non-operated limb amounted to 48.8% and 51.2%, respectively, and in group subjected to internal stabilization to 48.4% and 51.6%, respectively. Neither the intragroup nor the intergroup differences in the distribution of lower limb loads were statistically significant. Mean length of the center of gravity (COG) path was 137.9 cm for group 1 and 134 cm for group 2, and mean COG area amounted to 7.41 cm2 and 6.16 cm2, respectively. The latter intergroup difference was statistically significant. CONCLUSIONS Balance after ankle arthrodesis with Ilizarov fixation is worse than after the same procedure with internal stabilization. Despite correction of ankle deformity, musculoskeletal biomechanics still remains impaired. While ankle fusion with either Ilizarov or internal fixation provide appropriate distribution of lower limb loads, none of these procedures normalize patients' balance.
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Affiliation(s)
- Piotr Morasiewicz
- Department and Clinic of Orthopaedic and Traumatologic Surgery, Wrocław Medical University, ul. Borowska 213, 50-556 Wrocław, Poland
| | - Grzegorz Konieczny
- Faculty of Health Sciences and Physical Education, Witelon State University of Applied Sciences, Legnica, Poland
| | - Maciej Dejnek
- Department and Clinic of Orthopaedic and Traumatologic Surgery, Wrocław Medical University, ul. Borowska 213, 50-556 Wrocław, Poland
| | - Leszek Morasiewicz
- Department and Clinic of Orthopaedic and Traumatologic Surgery, Wrocław Medical University, ul. Borowska 213, 50-556 Wrocław, Poland
| | - Wiktor Urbański
- Department and Clinic of Orthopaedic and Traumatologic Surgery, Wrocław Medical University, ul. Borowska 213, 50-556 Wrocław, Poland
| | - Mirosław Kulej
- Department and Clinic of Orthopaedic and Traumatologic Surgery, Wrocław Medical University, ul. Borowska 213, 50-556 Wrocław, Poland
| | - Szymon Łukasz Dragan
- Department and Clinic of Orthopaedic and Traumatologic Surgery, Wrocław Medical University, ul. Borowska 213, 50-556 Wrocław, Poland
| | - Szymon Feliks Dragan
- Department and Clinic of Orthopaedic and Traumatologic Surgery, Wrocław Medical University, ul. Borowska 213, 50-556 Wrocław, Poland
| | - Łukasz Pawik
- Department of Physiotherapy and Occupational Therapy in Motor Disorders and Dysfunctions, University of Physical Education, Al. IJ Paderewskiego 35, Wroclaw, Poland
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Morasiewicz P, Urbański W, Kulej M, Dragan SŁ, Dragan SF, Pawik Ł. Balance and lower limb loads distribution after Ilizarov corticotomy. Injury 2018; 49:860-865. [PMID: 29571564 DOI: 10.1016/j.injury.2018.03.016] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2018] [Accepted: 03/14/2018] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Normal balance and symmetric distribution of lower limb loads are associated with adequate muscle strength, joint mobility and proprioception. The aim of this study was to analyze the distribution of lower limb loads and balance prior to and after axis correction and lengthening with Ilizarov method. MATERIALS AND METHODS The prospective analysis included 20 patients from our clinic, who have been subjected to distraction-corrective lower limb corticotomies with the Ilizarov method in 2014-2015. Balance and distribution of lower limb loads were determined with a pedobarographic platform. RESULTS Prior to the surgery, mean loads on affected and non-affected limbs corresponded to42%and58%of body weight, respectively. Mean loads on affected and non-affected limbs during the postoperative examination did not differ significantly. Mean path length of the center of gravity prior to and after the surgery amounted to143.27 cm and 125.11 cm, respectively. Mean area of the center of gravity was 7.81 cm2prior to the surgery and 5.81 cm2after the procedure. DISCUSSION Our present study showed that distraction-corrective Ilizarov corticotomy may provide more symmetric distribution of lower limb loads and improvement of balance. This outcome should be considered satisfactory from the perspective of the locomotor system statics. Corticotomies with Ilizarov method provide symmetric distribution of loads between non-affected and operated limb.
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Affiliation(s)
- Piotr Morasiewicz
- Wrocław Medical University, Department and Clinic of Orthopaedic and Traumatologic Surgery, Borowska 213, 50-556, Wrocław, Poland.
| | - Wiktor Urbański
- Wrocław Medical University, Department and Clinic of Orthopaedic and Traumatologic Surgery, Borowska 213, 50-556, Wrocław, Poland
| | - Mirosław Kulej
- Wrocław Medical University, Department and Clinic of Orthopaedic and Traumatologic Surgery, Borowska 213, 50-556, Wrocław, Poland
| | - Szymon Łukasz Dragan
- Wrocław Medical University, Department and Clinic of Orthopaedic and Traumatologic Surgery, Borowska 213, 50-556, Wrocław, Poland
| | - Szymon Feliks Dragan
- Wrocław Medical University, Department and Clinic of Orthopaedic and Traumatologic Surgery, Borowska 213, 50-556, Wrocław, Poland
| | - Łukasz Pawik
- University of Physical Education, Department of Physiotherapy and Occupational Therapy in Motor Disorders and Dysfunctions, Al. IJ Paderewskiego 35, Wroclaw, Poland
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Cheng T, Xia RG, Dong SK, Yan XY, Luo CF. Interlocking Intramedullary Nailing Versus Locked Dual-Plating Fixation for Femoral Shaft Fractures in Patients with Multiple Injuries: A Retrospective Comparative Study. J INVEST SURG 2017; 32:245-254. [PMID: 29252044 DOI: 10.1080/08941939.2017.1400131] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
PURPOSE Intramedullary nailing (IMN) is a popular method in the management of femoral shaft fractures (FSFs). However, whether the association of IMN with pulmonary fat emboli can compromise the pulmonary and nervous systems is debatable. The purpose of this study is to compare IMN with the locked dual plating (LDP) method by assessing the clinical outcomes of FSF patients with head or chest injury. METHOD A total of 126 FSF patients were included in this study between January 2010 and July 2016 and divided into LDP and IMN groups. Patient demographic characteristics, operative time, blood loss, Harris Hip Score, Lysholm Knee Score, radiological outcomes, and systemic complications were collected and compared between the two treatment groups. Patients were followed up for at least 12 months. RESULTS The LDP group performed better than IMN in terms of operative time, estimated blood loss amount, and malunion rate. Differences in function scores, fracture union rate, overall pulmonary complication rate, and in-hospital mortality between the two groups were not significant. Average radiographic union time was significantly longer in the LDP group (36.3 weeks) than in the IMN group (32.5 weeks). One case of fixation failure occurred postoperatively in the LDP group, whereas one case of fracture nonunion took place in the IMN group. CONCLUSION Our findings suggest that dual-plating fixation is a promising method for FSFs with multiple injuries. However, the retrospective nature of this study necessitates high-quality trials to be performed to assess the clinical efficiency of dual plating.
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Affiliation(s)
- Tao Cheng
- a Department of Orthopaedic Surgery , Shanghai Jiao Tong University affiliated Shanghai Sixth People's Hospital , Shanghai , People's Republic of China
| | - Rong-Gang Xia
- a Department of Orthopaedic Surgery , Shanghai Jiao Tong University affiliated Shanghai Sixth People's Hospital , Shanghai , People's Republic of China
| | - Shi-Kui Dong
- a Department of Orthopaedic Surgery , Shanghai Jiao Tong University affiliated Shanghai Sixth People's Hospital , Shanghai , People's Republic of China
| | - Xiao-Yu Yan
- a Department of Orthopaedic Surgery , Shanghai Jiao Tong University affiliated Shanghai Sixth People's Hospital , Shanghai , People's Republic of China
| | - Cong-Feng Luo
- a Department of Orthopaedic Surgery , Shanghai Jiao Tong University affiliated Shanghai Sixth People's Hospital , Shanghai , People's Republic of China
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Morasiewicz P, Dragan S, Dragan SŁ, Wrzosek Z, Pawik Ł. Pedobarographic analysis of body weight distribution on the lower limbs and balance after Ilizarov corticotomies. Clin Biomech (Bristol, Avon) 2016; 31:2-6. [PMID: 26518282 DOI: 10.1016/j.clinbiomech.2015.10.009] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2015] [Revised: 10/05/2015] [Accepted: 10/17/2015] [Indexed: 02/07/2023]
Abstract
BACKGROUND Symmetrical distribution of the load of the lower limbs and balance are among the determinants of proper biomechanics of the musculoskeletal system. So far, it has not been elucidated whether the correction of the axis and the equalization of the length of the lower limbs allow for achieving proper balance and load distribution. The aim of the present study was to compare load distribution and balance of patients who underwent Ilizarov method corticotomies with healthy controls. METHODS The clinical studies evaluated 57 patients, who underwent corticotomy with the Ilizarov method. The control group consisted of 59 healthy volunteers. The evaluation assessed the distribution of the load of the lower limbs and balance using pedobarographic platform. FINDINGS In the study group operated limb bore 48.02% of the load on average, while the healthy limb 51.98%. These differences were not statistically significant. The average percentage of load in limbs in treated and control groups did not differ significantly. In the study group, the average length of path of the center of gravity was 145.47cm. In the control group, the average length of path of the center of gravity was 112.69cm. In the study group, the average area of the center of gravity was 7.54cm(2), while in the control group it was 5.19cm(2). INTERPRETATION Ilizarov method corticotomy allows for the obtainment value of the load distribution of the lower limbs in the study group not significantly different from those in a control group, but does not ensure the achievement of completely normal balance.
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Affiliation(s)
- Piotr Morasiewicz
- Wrocław Medical University, Department and Clinic of Orthopaedic and Traumatologic Surgery, Borowska 213, 50-556 Wrocław, Poland.
| | - Szymon Dragan
- Wrocław Medical University, Department and Clinic of Orthopaedic and Traumatologic Surgery, Borowska 213, 50-556 Wrocław, Poland
| | - Szymon Łukasz Dragan
- Wrocław Medical University, Department and Clinic of Orthopaedic and Traumatologic Surgery, Borowska 213, 50-556 Wrocław, Poland
| | - Zdzisława Wrzosek
- University of Physical Education in Wrocław, The Chair of Physiotherapy and occupational therapy in Motor System Dysfunctions, Paderewskiego 35, 51-612 Wrocław, Poland
| | - Łukasz Pawik
- University of Physical Education in Wrocław, The Chair of Physiotherapy and occupational therapy in Motor System Dysfunctions, Paderewskiego 35, 51-612 Wrocław, Poland
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Fang C, Gibson W, Lau TW, Fang B, Wong TM, Leung F. Important tips and numbers on using the cortical step and diameter difference sign in assessing femoral rotation--should we abandon the technique? Injury 2015; 46:1393-9. [PMID: 25912184 DOI: 10.1016/j.injury.2015.04.009] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2014] [Revised: 03/31/2015] [Accepted: 04/06/2015] [Indexed: 02/02/2023]
Abstract
Rotational malalignment during femoral nailing is common despite having various intraoperative assessment methods. The cortical step sign and diameter difference sign (CSSDDS) is commonly used because of convenience, yet it lack proper scientific scrutiny and is thought to be error prone. Using a software algorithm, cross-sectional dimensions were obtained from CT scans of 22 intact adult femurs at the proximal, mid and distal diaphysis. With multiple simulated scenarios the sensitivity of CSSDDS was comprehensively determined at all possible C-arm positions. At rotation, cortical width changed most significantly around the thick linea aspera and femoral diameter changed most significantly at the sagittal plane. At 15 degrees of rotation and with the linea aspera in view, CSSDDS thresholds of 0.3mm, 0.6mm and 1mm had sensitivities of 98.8%, 93.1% and 73.8%. With the linea aspera masked behind the femur and out of view, the sensitivities significantly deteriorated to 96.4%, 77.1% and 44.1% respectively. CSSDDS is sufficiently sensitive only when strict rules are followed. It is imperative that the operator position the image intensifier in lateral view under proper magnification so that steps of less than 0.6mm around the linea aspera may be appreciated.
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Affiliation(s)
- C Fang
- Department of Orthopaedics and Traumatology, The University of Hong Kong, Queen Mary Hospital, China.
| | - W Gibson
- The Medical School, The University of Sheffield, Sheffield, United Kingdom.
| | - T W Lau
- Department of Orthopaedics and Traumatology, The University of Hong Kong, Queen Mary Hospital, China.
| | - B Fang
- Department of Radiology, Queen Mary Hospital, Hong Kong, China.
| | - T M Wong
- Department of Orthopaedics and Traumatology, The University of Hong Kong, Queen Mary Hospital, China; Shenzhen Key Laboratory for Innovative Technology in Orthopaedic Trauma, The University of Hong Kong-Shenzhen Hospital, Shenzhen, China.
| | - F Leung
- Department of Orthopaedics and Traumatology, The University of Hong Kong, Queen Mary Hospital, China; Shenzhen Key Laboratory for Innovative Technology in Orthopaedic Trauma, The University of Hong Kong-Shenzhen Hospital, Shenzhen, China.
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Computerized navigation for length and rotation control in femoral fractures: a preliminary clinical study. J Orthop Trauma 2014; 28:e27-33. [PMID: 23695376 DOI: 10.1097/bot.0b013e31829aaefb] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
OBJECTIVE Operative treatment of femoral fractures yields a predictably high union rate, but residual malrotation and leg length discrepancy remain a clinically significant problem. The aim of this study was to determine the safety and efficacy of using computerized navigation in controlling the length and rotation in femoral fracture surgery. DESIGN Prospective consecutive case series of 16 skeletally mature patients with femoral fractures undergoing surgical fixation; 14 were fixed with intramedullary nails and 2 with plates. SETTING An Academic Level I trauma center. INTERVENTION Computerized navigation was used to determine the length and rotation of the operated extremity as compared with the intact healthy contralateral side. MAIN OUTCOME MEASURE All patients underwent postoperative computed tomography scanogram for determining the length and rotation. RESULTS All fractures healed. Mean rotational difference between the treated and nontreated sides was 3.45 degrees (range, 0-7.7 degrees). Mean length difference between the 2 extremities as calculated by the computed tomography scan was 5.83 mm (range, 0-13 mm). Additional operative time required for computerized navigation was measured in 2 of the cases and totaled ∼30-35 min/case. CONCLUSION Computerized navigation was accurate and precise at restoring femoral length and rotation during femoral fracture fixation when the intact contralateral femur was used for reference. Further, large-scale randomized studies are required. Additionally, improvements aimed at decreasing operative time and improving user interface of these systems are recommended. LEVEL OF EVIDENCE Therapeutic level IV. See instructions for authors for a complete description of the levels of evidence.
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Yoon RS, Koerner JD, Patel NM, Sirkin MS, Reilly MC, Liporace FA. Impact of specialty and level of training on CT measurement of femoral version: an interobserver agreement analysis. J Orthop Traumatol 2013; 14:277-81. [PMID: 23989857 PMCID: PMC3828493 DOI: 10.1007/s10195-013-0263-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2013] [Accepted: 07/22/2013] [Indexed: 10/31/2022] Open
Abstract
BACKGROUND To determine the interobserver agreement on femoral version measurements between an orthopedic attending, orthopedic senior and junior residents, and an attending radiologist. MATERIALS AND METHODS Postoperative computed tomography (CT) scanograms of 267 patients who underwent femoral intramedullary (IM) nailing with corresponding radiology attending reads for femoral version were collected and de-identified. Femoral version measurements performed by a trauma fellowship-trained attending orthopedic surgeon (ORTHO), a senior orthopedic resident (PGY4), a junior orthopedic resident (PGY1), and a musculoskeletal fellowship-trained attending radiologist (RADS) were compared via Pearson's interclass correlation coefficient to assess interobserver level of agreement. RESULTS Version measurements provided by the two attending physicians exhibited the highest level of agreement (r = 0.661, p < 0.01). The orthopedic attending and the senior resident had the next highest level of agreement (r = 0.543, p < 0.01). The first-year orthopedic resident had the weakest agreement across the board: with the orthopedic attending, the radiology attending, and the senior resident. CONCLUSION Regardless of specialty, experience and higher levels of training produce stronger agreement when measuring femoral version. Residents in training, especially those who are junior, produce weak agreement when compared to their senior colleagues. LEVEL OF EVIDENCE Level III, diagnostic study.
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Affiliation(s)
- Richard S Yoon
- Division of Orthopaedic Trauma, Department of Orthopaedic Surgery, NYU Hospital for Joint Diseases, 301 E 17th Street, Suite 1402, New York, NY, 10003, USA,
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Abstract
Intramedullary nailing of femoral shaft fracture can result in inadvertent malalignment. Malrotation is the most common cause of deformity, but it is underrecognized, in part because of the difficulty in accurately assessing rotation as well as the variation that exists in normal anatomy. The consequences of femoral malrotation are not completely understood. However, initial biomechanical studies suggest that it causes a substantial change in load bearing in the affected extremity. Clinical examination, fluoroscopy, and ultrasonography are useful in measuring femoral rotational alignment intraoperatively and postoperatively. CT is useful in the identification of the degree of malrotation and in surgical planning.
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