Abstract
Objective
To determine the incidence of rotational malalignment in distal femoral and proximal
tibial fractures using computed tomography (CT) scanograms following indirect reduction
and internal fixation with the minimally invasive percutaneous osteosynthesis (MIPO)
technique.
Design
Prospective Cohort.
Setting
Level I Trauma Centre.
Patients/Participants
A total of 27 consecutive subjects, and 14 proximal tibia and distal femur fractures.
Intervention
All patients underwent indirect reduction and internal fixation with a MIPO plating
system. A CT scanogram to measure rotational malalignment between the injured and
non-injured extremity was then undertaken.
Main outcome measure(s)
Femoral anteversion angles and tibial rotation angles between the injured and non-injured
extremities were compared. Malrotation was defined as a side-to-side difference of
>10°.
Results
A total of 14 postoperative tibias and 13 femurs underwent CT scanograms. Three females
and 11 males with an average age of 38.1 years sustained proximal tibia fractures
and six females and seven males with an average age of 55.8 years sustained distal
femur fractures. The difference between tibial rotation in the injured and the non-injured
limbs ranged from 2.7 to 40.0° with a mean difference of 16.2° (p = 0.656, paired T-test). Fifty percent of the tibias fixed with MIPO plates were malrotated >10° from
the uninjured limbs. The difference between femoral anteversion in the injured and
non-injured limbs ranged from 2.0 to 31.3° with a mean difference of 11.5° (p = 0.005, paired T-test). A total of 38.5% of the distal femurs fixed with MIPO plates were malrotated
>10° from the uninjured limb.
Conclusions
Following fixation of distal femoral and proximal tibial fractures, the incidence
of malrotation was 38.5% and 50%, respectively. The difference of the mean measures
was significant for femoral malrotation; however, statistical significance could not
be demonstrated for tibial malrotation. The incidence of malrotation following MIPO
plating in this study is much higher than that quoted in previous studies.
Keywords
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Article info
Publication history
Accepted:
August 18,
2010
Identification
Copyright
© 2010 Elsevier Ltd. Published by Elsevier Inc. All rights reserved.
