Skip to main content

Advertisement

SpringerLink
Log in

Intramedullary nailing of femoral shaft fractures: an analysis of rotational malunions using 3D EOS

  • Original Article
  • Published:
European Journal of Orthopaedic Surgery & Traumatology Aims and scope Submit manuscript

Abstract

Purpose

Rotational malalignment and leg length discrepancy after intramedullary nailing of femoral shaft are frequent. This study has three objectives: evaluate the rate of femoral rotational malalignment and leg length discrepancy using EOS imaging after antegrade intramedullary nailing of femoral shaft fracture, find a relevant clinical examination to detect malrotation and identified risk factors.

Methods

We performed a retrospective single-centre study between January 2014 and January 2022. Fifty-eight patients were clinically and radiographically assessed at a minimum of three months.

Results

The femoral rotation of the operated side was significantly greater by a mean of 15.4° in internal rotation compared to the healthy side. There was no statically significant difference for the femoral length (p = 0.08).

Conclusion

When using EOS stereography following antegrade intramedullary nailing of post-traumatic diaphyseal femur fractures, a statistically significant difference of more than 15.4° in internal rotation was found for femoral rotation on the operated side compared to the healthy side.Please confirm if the author names are presented accurately and in the correct sequence (given name, middle name/initial, family name). Author 1 Given name: [B. Poirot] Last name [Seynaeve]. Also, kindly confirm the details in the metadata are correct.The last name of the first author was corrected : Given name = B. and last name = Poirot Seynaeve The details in matadata are correct

Level of evidence

III.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5

Similar content being viewed by others

References

  1. Winquist RA, Hansen ST, Clawson DK (1984) Closed intramedullary nailing of femoral fractures. A report of five hundred and twenty cases. J Bone Joint Surg Am 66(4):529–539

    Article  CAS  PubMed  Google Scholar 

  2. Alho A, Strømsøe K, Ekeland A (1991) Locked intramedullary nailing of femoral shaft fractures. J Trauma 31(1):49–59. https://doi.org/10.1097/00005373-199101000-00011

    Article  CAS  PubMed  Google Scholar 

  3. Orfeuvre B, Tonetti J, Kerschbaumer G, Barthelemy R, Moreau-Gaudry A, Boudissa M (2021) EOS stereographic assessment of femoral shaft malunion after intramedullary nailing. A prospective series of 48 patients at 9 months’ follow-up. Orthop Traumatol Surg Res OTSR 107(2):102805. https://doi.org/10.1016/j.otsr.2021.102805

    Article  PubMed  Google Scholar 

  4. Bonnevialle P, Andrieu S, Bellumore Y, Challé JJ, Rongières M, Mansat M (1998) Torsional abnormalities and length discrepancies after intramedullary nailing for femoral and tibial diaphyseal fracture. Computerised tomography evaluation of 189 fractures. Rev Chir Orthop Reparatrice Appar Mot 84(5):397–410

    CAS  PubMed  Google Scholar 

  5. Herscovici D, Scaduto JM (2014) Assessing leg length after fixation of comminuted femur fractures. Clin Orthop 472(9):2745–2750. https://doi.org/10.1007/s11999-013-3292-0

    Article  PubMed  Google Scholar 

  6. Gheraibeh P, Vaidya R, Hudson I, Meehan R, Tonnos F, Sethi A (2018) Minimising leg length discrepancy after intramedullary nailing of comminuted femoral shaft fractures: a quality improvement initiative using the scout computed tomography scanogram. J Orthop Trauma 32(5):256–262. https://doi.org/10.1097/bot.0000000000001135

    Article  PubMed  Google Scholar 

  7. Kim C, Nevitt M, Guermazi A, Niu J, Clancy M, Tolstykh I et al (2018) Leg length inequality and hip osteoarthritis in the multicentre osteoarthritis study and the osteoarthritis initiative. Arthritis Rheumatol Hoboken NJ 70(10):1572–1576. https://doi.org/10.1002/art.40537

    Article  Google Scholar 

  8. Karaman O, Ayhan E, Kesmezacar H, Seker A, Unlu MC, Aydingoz O (2014) Rotational malalignment after closed intramedullary nailing of femoral shaft fractures and its influence on daily life. Eur J Orthop Surg Traumatol 24(7):1243–1247. https://doi.org/10.1007/s00590-013-1289-8

    Article  PubMed  Google Scholar 

  9. Goutallier D, Van Driessche S, Manicom O, Sariali E, Ali ES, Bernageau J et al (2006) Influence of lower-limb torsion on long-term outcomes of tibial valgus osteotomy for medial compartment knee osteoarthritis. J Bone Joint Surg Am 88(11):2439–2447. https://doi.org/10.2106/jbjs.e.01130

    Article  PubMed  Google Scholar 

  10. Abadie P, Galaud B, Michaut M, Fallet L, Boisrenoult P, Beaufils P (2009) Distal femur rotational alignment and patellar subluxation: a CT scan in vivo assessment. Orthop Traumatol Surg Res OTSR 95(4):267–271. https://doi.org/10.1016/j.otsr.2009.04.004

    Article  CAS  PubMed  Google Scholar 

  11. Folinais D, Thelen P, Delin C, Radier C, Catonne Y, Lazennec JY (2013) Measuring femoral and rotational alignment: EOS system versus computed tomography. Orthop Traumatol Surg Res OTSR 99(5):509–516. https://doi.org/10.1016/j.otsr.2012.12.023

    Article  CAS  PubMed  Google Scholar 

  12. Terjesen T, Benum P, Anda S, Svenningsen S (1982) Increased femoral anteversion and osteoarthritis of the hip joint. Acta Orthop Scand 53(4):571–575. https://doi.org/10.3109/17453678208992260

    Article  CAS  PubMed  Google Scholar 

  13. Mahmood S, Huffman LK, Harris JG (2010) Limb-length discrepancy as a cause of plantar fasciitis. J Am Podiatr Med Assoc 100(6):452–455. https://doi.org/10.7547/1000452

    Article  PubMed  Google Scholar 

  14. Vink P, Kamphuisen HA (1989) Leg length inequality, pelvic tilt and lumbar back muscle activity during standing. Clin Biomech Bristol Avon 4(2):115–117. https://doi.org/10.1016/0268-0033(89)90049-1

    Article  CAS  PubMed  Google Scholar 

  15. Gurney B, Mermier C, Robergs R, Gibson A, Rivero D (2001) Effects of limb-length discrepancy on gait economy and lower-extremity muscle activity in older adults. J Bone Joint Surg Am jun 83(6):907–915. https://doi.org/10.2106/00004623-200106000-00013

    Article  CAS  Google Scholar 

  16. Grill F, Chochole M, Schultz A (1990) Pelvic tilt and leg length discrepancy. Orthopade 19(5):244–262

    CAS  PubMed  Google Scholar 

  17. McCaw ST, Bates BT (1991) Biomechanical implications of mild leg length inequality. Br J Sports Med 25(1):10–13. https://doi.org/10.1136/bjsm.25.1.10

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  18. Lindsey JD, Krieg JC (2011) Femoral malrotation following intramedullary nail fixation. J Am Acad Orthop Surg 19(1):17–26. https://doi.org/10.5435/00124635-201101000-00003

    Article  PubMed  Google Scholar 

  19. Boscher J, Alain A, Vergnenegre G, Hummel V, Charissoux J-L, Marcheix P-S (2022) Femoral shaft fractures treated by antegrade locked intramedullary nailing: EOS stereoradiographic imaging evaluation of rotational malalignment having a functional impact. OTSR 108(5):103235. https://doi.org/10.1016/j.otsr.2022.103235

    Article  PubMed  Google Scholar 

  20. Muller ME, Nazarian S, Koch P, Schatzker J (1990) The AO classification of fractures of long bones. Springer-Verlag, Berlin

    Book  Google Scholar 

  21. Reina N, Cognault J, Ollivier M, Dagneaux L, Gauci MO, Pailhé R (2018) The CJOrtho app: a mobile clinical and educational tool for orthopaedics. OTSR 104(4):523–527. https://doi.org/10.1016/j.otsr.2018.01.022

    Article  CAS  PubMed  Google Scholar 

  22. Ornetti P, Parratte S, Gossec L, Tavernier C, Argenson J-N, Roos EM et al (2008) Cross-cultural adaptation and validation of the French version of the Knee injury and Osteoarthritis Outcome Score (KOOS) in knee osteoarthritis patients. Osteoarthritis Cartilage 16(4):423–428. https://doi.org/10.1016/j.joca.2007.08.007

    Article  CAS  PubMed  Google Scholar 

  23. Jaarsma RL, Ongkiehong BF, Grüneberg C, Verdonschot N, Duysens J, van Kampen A (2004) Compensation for rotational malalignment after intramedullary nailing for femoral shaft fractures: an analysis by plantar pressure measurements during gait. Injury 35(12):1270–1278. https://doi.org/10.1016/j.injury.2004.01.016

    Article  CAS  PubMed  Google Scholar 

  24. Branca Vergano L, Coviello G, Monesi M (2020) Rotational malalignment in femoral nailing: prevention, diagnosis and surgical correction. Acta Bio-Medica Atenei Parm. 91(14-S):e2020003. https://doi.org/10.23750/abm.v91i14-s.10725

    Article  Google Scholar 

Download references

Funding

The authors declare that no funds, grants, or other support were received during the preparation of this manuscript.

Author information

Authors and Affiliations

  1. UFR Médecine, University of Reims Champagne Ardenne, 51 Rue Cognacq Jay, 51100, Reims, France

    B. Poirot Seynaeve, P. Gentilhomme, D. Tran-Minh, N. Zran, X. Ohl, R. Siboni & E. Joseph

  2. Department of Orthopaedic Surgery, Reims University Hospital, Hôpital Maison Blanche, 45 Rue Cognacq-Jay, 51092, Reims, France

    B. Poirot Seynaeve, P. Gentilhomme, D. Tran-Minh, N. Zran, X. Ohl, R. Siboni & E. Joseph

  3. Biomaterial and Inflammation in Bone Site Laboratory (EA 4691 Bios), University of Reims Champagne Ardenne, 51 Rue Cognacq Jay, 51100, Reims, France

    X. Ohl & R. Siboni

Authors
  1. B. Poirot Seynaeve
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. P. Gentilhomme
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. D. Tran-Minh
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. N. Zran
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. X. Ohl
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. R. Siboni
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. E. Joseph
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

BPS, NZ and EJ have made substantial contributions to conception, study design. BPS, PG & DTM took part in data acquisition/interpretation. RS and XO have been involved in drafting or revising the manuscript critically. XO, RS and EJ are the main surgeons. Each author has given final approval of the version to be published and agrees to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

Corresponding author

Correspondence to R. Siboni.

Ethics declarations

Conflict of interest

The authors have no conflict of interest to report.

Ethical approval

This study was approved by the Institutional Review Board: MR0042206749v0.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Poirot Seynaeve, B., Gentilhomme, P., Tran-Minh, D. et al. Intramedullary nailing of femoral shaft fractures: an analysis of rotational malunions using 3D EOS. Eur J Orthop Surg Traumatol 34, 1893–1899 (2024). https://doi.org/10.1007/s00590-024-03868-z

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00590-024-03868-z

Keywords

Search

Navigation