Femoral malrotation following intramedullary nailing in bilateral femoral shaft fractures

This study was designed to evaluate the incidence of femoral malrotation in bilateral femoral shaft fractures. All closed bilateral femoral shaft fractures in patients aged 18 or over treated between April 2000 and December 2009 were included in the current study. All patients received a postoperative CT-scan to estimate femoral antetorsion and leg length. All bilateral fractures were treated with intramedullary nailing on a radiolucent table. Retrospectively, all patients were analyzed according to the following parameters: (1) femoral antetorsion of both limbs and antetorsion difference in degrees, (2) femoral length discrepancy (cm), (3) incidence of femoral malrotation > 15A degrees, (4) revision rate due to femoral malrotation. A total of 24 patients (11 [45.8%] female; 13 [52.8%] male) with bilateral femoral shaft fractures were included in this study of average age 38 years (median 38 years, range 18-74 years). Clinically relevant malrotation (greater than 15A degrees) was found in 10 cases (41.2%), whereas in 4 cases (40%) a revision surgery was required. Bilateral femoral shaft fractures are associated with a high incidence of clinically relevant femoral malrotation over 15A degrees. Measurement of intraoperative femoral antetorsion in bilateral femoral shaft fractures is quite difficult and currently only feasible postoperatively.