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Use of Espinoza technique may reduce malrotation in cases with comminuted femur fractures
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Malrotation of the femur after comminuted fracture during locked intramedullary nailing may be minimized with the use of the inherent anteversion of a second-generation nail in patients with normal anteversion, according to recently published results.
Rahul Vaidya, MD, and colleagues assessed rotation in 52 patients with comminuted femoral shaft fractures treated with locked intramedullary nailing using either the patellar shadow and lesser trochanter (traditional group; n=27) or by using the Espinoza technique (n=25). Researchers performed CT scanography to determine femoral anteversion and length in the normal vs. operated femur.
Results showed 29% of patients in the traditional group had a greater than 15° difference from native to operative leg vs. 2.5% in the Espinoza technique group. Researchers noted a mean difference from native to operative legs of approximately 11.6° and 4.8° in the traditional and Espinoza technique groups, respectively. Researchers found a 5° variability in the ability to center the proximal locking screw in the femoral head, as well as a 5° variation in distal locking.
“Rotational malalignment is the most common complication of locked intramedullary nailing of femur fracture (reported to be 20% to 50%). The average anteversion of femurs is 9°. Patients tolerate up to 15° of malrotation,” Vaidya told Healio.com/Orthopedics. “If the fracture is comminuted, it can be difficult to get the rotation correct with standard fluoroscopic means. Using a second-generation nail to set the anteversion during nailing as described by Espinosa and colleagues is a great way to prevent this common issue.” – by Casey Tingle
Disclosures: Vaidya reports he receives royalties from Smith & Nephew and Synthes; is a paid consultant for Smith & Nephew; receives research support as a principle investigator from Pfizer Strive Study; and is on the editorial or governing board for the European Spine Journal and the Journal of Orthopaedic Trauma. Please see the full study for a list of all other authors’ relevant financial disclosures.
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