Title : Incidence and functional impact of malrotation following intramedullary nailing of femoral fractures: A prospective CT-based study
Abstract:
Background: Rotational malalignment remains a prevalent yet under-recognised complication following closed intramedullary nailing of femoral shaft fractures. Although computed tomography (CT) provides an accurate assessment, literature correlating malrotation with functional impairment remains sparse. The primary aim of this study was to evaluate the incidence and degree of femoral malrotation post-intramedullary fixation and its impact on lower limb functional outcomes.
Methods: This prospective longitudinal study was conducted at a tertiary trauma centre over 18 months. Thirty skeletally mature patients with acute diaphyseal and diaphysio-metaphyseal femoral fractures underwent closed antegrade intramedullary nailing. Postoperative rotational alignment was quantified using CT scans based on the Jeanmart method. Functional outcomes were assessed at 6 weeks, 12 weeks, and 6 months postoperatively using the Lower Extremity Functional Scale (LEFS). Statistical analyses employed paired t-tests, independent t-tests, ANOVA, and Pearson’s correlation coefficient, with significance set at p<0.05.
Results: The mean patient age was 28.7 years, with a male predominance (86.7%). Rotational malalignment exceeding 10° was identified in 20% of cases. Mean internal rotation deformity measured 12.6°, and mean external rotation deformity was 8°. Malrotation >10° was significantly associated with inferior LEFS scores (p<0.05). Preoperative fracture comminution demonstrated a significant correlation with increased malrotation (p<0.001). Delayed surgical intervention beyond 10 days was linked to poorer functional recovery (p=0.0086). Radiological union was achieved between 3 to 6 months in the majority, with universal patient satisfaction at final follow-up.
Conclusion: Rotational malalignment following femoral intramedullary nailing adversely affects functional outcomes when exceeding 10°, with a measurable impact on gait and limb performance.
Implications: Routine postoperative CT-based rotational assessment may be considered in high-risk cases (comminuted fractures and delayed presentations) to allow early detection and potential corrective intervention, thereby preventing long-term functional deficits.
Disclosure: The authors report no conflicts of interest related to this study.
