Malrotation following reamed intramedullary nailing of closed tibial fractures

Background: Rotational malalignment after intramedullary tibial nailing is rarely addressed in clinical studies. Malrotation (especially > 10 degrees) of the lower extremity can lead to development and progression of degenerative changes in knee and ankle joints. The purpose of this study is to determine the incidence and severity of tibial malrotation after reamed intramedullary nailing for closed diaphyseal tibial fractures. Materials and Methods: Sixty patients (53 males and 7 females) with tibial diaphyseal fracture were included in this study. The mean age of the patients was 33.4 +/- 13.3 years. All fractures were manually reduced and fixed using reamed intramedullary nailing. A standard method using bilateral limited computerized tomography was used to measure the tibial torsion. A difference greater than 10 between two tibiae was defined as malrotation. Results: Eighteen (30%) patients had malrotation of more than 10. Malrotation was greater than 15 in seven cases. Good or excellent rotational reduction was achieved in 70% of the patients. There was no statistically significant relation between AO tibial fracture classification and fibular fixation and malrotation of greater than 10. Conclusions: Considering the high incidence rate of tibial malrotation following intramedullary nailing, we need a precise method to evaluate the torsion intraoperatively to prevent the problem.