Narrative review synthesizing the incidence, measurement methods, intraoperative causes, prevention strategies, and clinical consequences of rotational malalignment after intramedullary nailing of femoral shaft fractures. Addresses why clinical assessment systematically underestimates the problem and how CT — despite being the gold standard — has its own meaningful measurement error.
When nailing a femoral shaft fracture, actively compare the lesser trochanter profile on C-arm between the injured and contralateral side — clinical examination alone will miss rotational malalignment in a large proportion of patients, and even CT has measurement error approaching the threshold for "true" deformity.
If a patient reports more functional difficulty than expected after femoral nailing, assess the direction of any malrotation: external malrotation consistently produces worse symptoms and poorer functional scores than internal, and should lower your threshold for further workup or correction.
Narrative review synthesizing the incidence, measurement methods, intraoperative causes, prevention strategies, and clinical consequences of rotational malalignment after intramedullary nailing of femoral shaft fractures. Addresses why clinical assessment systematically underestimates the problem and how CT — despite being the gold standard — has its own meaningful measurement error.
When nailing a femoral shaft fracture, actively compare the lesser trochanter profile on C-arm between the injured and contralateral side — clinical examination alone will miss rotational malalignment in a large proportion of patients, and even CT has measurement error approaching the threshold for "true" deformity.
If a patient reports more functional difficulty than expected after femoral nailing, assess the direction of any malrotation: external malrotation consistently produces worse symptoms and poorer functional scores than internal, and should lower your threshold for further workup or correction.