[Assessment of axis deviation following tibial intramedullary nailing in the standard roentgen image]

Evaluation of 87 fixations of the lower leg revealed that standard x-ray film safely enables accurate determination of defective axial and lateral positioning. Assessment of rotatory malpositioning is unsafe and not likely to yield accurate results. The only possibility is to take the x-ray film of the fixed foot; this enables conclusions from measurements performed on the x-ray film with the metal still implanted and the fixation still in place, as reference parameters. Detailed analysis of the x-ray films, however, revealed even further results: delayed and disturbed healing of bone fractures can be detected early from the mechanical measurement data on the x-ray film, so that correction of the fixation nail can be made well in time. Cases treated in this way healed properly and in a well-adjusted manner. Corrections performed with the fixation nail were pseudoarthroses (5 cases), 4 of which healed without complications whereas one healed after removal of the nail and conservative aftercare. Fractures in the distal part of the lower leg seem to be particularly critical. Because of the close proximity of the ankle joint, unsatisfactory stability will result if the nail end is too short.