Effect of Inherent Tibial Asymmetry on Leg Length Discrepancy Measurements After Intramedullary Nailing of Comminuted Femoral Shaft Fractures

Overview

Journal SICOT J

Publisher EDP Sciences

Specialty Orthopedics

Date 2019 Jan 12

PMID 30632481

Citations 1

Authors

Ian Hudson

Krystalyn Mauch

Meg Schuurman

Muhammad T Padela

Petra Gheraibeh

Rahul Vaidya

Affiliations

Soon will be listed here.

Abstract

Introduction: Locked intramedullary nailing (IMN) is the standard treatment for femoral shaft fractures in adults with high rates of union and relatively low rates of complications. Leg length discrepancy (LLD) after IMN of femoral shaft fractures is common, and is reported in 20-43% of cases. A known surgical challenge when trying to obtain equal leg lengths is comminuted fracture, which results in a loss of bony landmarks that guide reduction. The purpose of this study was to assess the effect of inherent tibial asymmetry on LLD measurements after IMN.

Methods: Postoperative CT scanograms were performed on 79 consecutive patients after locked IMN for comminuted femoral shaft fracture. Leg lengths were determined by measurements taken from the scout view of a CT scanogram. Calculations of discrepancy were made for both femurs, tibias, and total leg length. Assessment was also made on the frequency wherein the tibial discrepancy compounded the femoral discrepancy. In situations where a limb segment was exactly symmetric to the contralateral side, the total leg was not regarded as a having compounded asymmetry.

Results: Notable discrepancies were found in tibial length that significantly departed from the null of symmetry (p < 0.0001). Forty-two patients (53.2%) were found to have a tibial asymmetry of 3 mm or more, and 20 patients (25.3%) were found to exhibit a difference of 6.3 mm or more. Median femoral discrepancy was 5.3 mm and median tibial discrepancy was 3.0 mm. Seven patients were found to be asymmetric in total leg length as a consequence of underlying tibial asymmetry. Conversely, 11 patients benefited from their tibial asymmetry, which compensated for femoral asymmetry after IMN.

Conclusion: Tibial symmetry cannot be assumed. If not accounted for, inherent tibial asymmetry may influence LLD after IMN of femur fractures.

Citing Articles

The lesser trochanter profile is an accurate and reliable measure of femoral rotation for intramedullary nailing.

Mao J, Al-Jamal M, Allen D, Henry B, Court T, Vaidya R SICOT J. 2024; 10:36.

PMID: 39303142 PMC: 11415034. DOI: 10.1051/sicotj/2024036.

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