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Beitragstitel Flouroscopic control of tibial torsion after intramedullary nailing of tibia fractures, a technical trick
Beitragscode P28
  1. Henrik Eckardt Universätsspital Basel (USB) Vortragender
  2. Mario Morgenstern Universitätsspital Basel
  3. Dieter Cadosch Kantonsspital Aarau
  4. Karl Stoffel Universitätsspital Basel (USB)
Präsentationsform Poster
  • A05 - Knie
Abstract After intramedullary nailing of tibia shaft fractures, torsional malalignment greater than 10° occur in up to 41% of operated legs. The reason is the difficult clinical assessment of rotation intraoperatively, the large variation in absolute torsion of the tibia and the absence of established reliable methods to fluoroscopically evaluate tibial rotation and compare to the contralateral side. We present here a fast and low-tech intraoperative method on how to achieve identical tibial torsion of the operated and non-injured side. The method can be used for tibia shaft and metaphyseal fractures and only requires a normal C-arm fluoroscope with two monitors. First, a true lateral image of the knee on the non-injured side with the femoral condyles aligned is obtained. Second, with the leg and the C-arm rotation and tilt fixed, the fluoroscope is moved parallel to the patient axis and a lateral ankle image is obtained and saved. The fibula position relative to the tibia at the level of the Volkmann tubercle on the lateral view defines the torsion of the tibia. The sequence described above is repeated on the operated side after implantation of the nail before proximal locking. On the operated side, the fibula position relative to the tibia should be identical to the non-injured side before proximal locking takes place. Otherwise a rotational malalignment is present and must be corrected. The comparison between operated and non-injured side is easy on a fluoroscope with two monitors. The complete examination takes a few minutes and has minor additional radiation exposure. We performed the intra-operative torsion control in 10 patients and performed a post-operative low-dose CT-control of the torsion of both legs and found the rotational deformity to be less than 10° in all patients.