Rotational malalignment after intramedullary fixation of trochanteric fractures

Introduction: Rotational malalignment after intramedullary fixation of fractures of the shaft of femur and tibia has been assessed by many studies but less frequently after intramedullary fixation of intertrochanteric fractures. Intertrochanteric fractures are managed by closed reduction in a traction table and fixation either by dynamic hip screw or proximal femoral nail under image intensifier. Reduction is checked intraoperatively by antero-posterior and lateral views with image intensifier in which rotational alignment cannot be assessed. Aim: To study the rotational malalignment in the operated limb compared to normal limb by computed tomography (CT). Materials and Methods: A prospective study was conducted on 70 patients at Kasturba Medical College and allied hospitals with intertrochanteric fractures with intramedullary fixation and with normal anatomy on opposite side. Postoperative CT with pelvis and knee was done and compared for rotational alignment. Results: The mean anteversion on the normal side was 13.20. The mean anteversion on the operated side was 15.70. The mean rotational malalignment was 9.70; there was internal rotational deformity in 41 cases (58.6%) and external rotational deformity in 29 cases (41.4%) with Grade III malrotation in 17 (24.3%) cases. Conclusion: Rotational malalignment postoperatively is frequently present and needs to be corrected intraoperatively by improving assessment methods.