This 2011 narrative review by Lindsey and Krieg examines femoral malrotation as a complication of IM nailing for femoral shaft fractures — how often it occurs, why it is missed, what it does to the limb biomechanically, and how to detect and correct it intraoperatively and postoperatively.
When nailing a femoral shaft fracture, default clinical assessment is insufficient — actively use intraoperative fluoroscopic anteversion matching or the lesser trochanteric profile technique, and be especially vigilant with fracture table positioning, which triples the rate of internal malrotation.
If malrotation is suspected postoperatively, CT rotational profile is the most reliable quantification tool and should guide the decision between early interlock revision versus late derotational osteotomy.
This 2011 narrative review by Lindsey and Krieg examines femoral malrotation as a complication of IM nailing for femoral shaft fractures — how often it occurs, why it is missed, what it does to the limb biomechanically, and how to detect and correct it intraoperatively and postoperatively.
When nailing a femoral shaft fracture, default clinical assessment is insufficient — actively use intraoperative fluoroscopic anteversion matching or the lesser trochanteric profile technique, and be especially vigilant with fracture table positioning, which triples the rate of internal malrotation.
If malrotation is suspected postoperatively, CT rotational profile is the most reliable quantification tool and should guide the decision between early interlock revision versus late derotational osteotomy.