Rotational Malalignment After Intramedullary Nailing of Tibial Shaft Fractures Is Predictable

Area of Science:

• Orthopedic surgery
• Trauma care
• Biomechanical analysis

Background:

• Intramedullary nailing is the standard treatment for tibial shaft fractures (TSF).
• A significant complication is iatrogenic rotational malalignment.
• Predicting and preventing this malalignment is crucial for optimal patient outcomes.

Purpose of the Study:

• To identify predictors of rotational malalignment following intramedullary nailing of tibial shaft fractures.
• To develop a predictive model for postoperative rotational differences.

Main Methods:

• Retrospective study at a single level 1 trauma center.
• Included 154 patients who underwent unilateral intramedullary nailing for TSF.
• Postoperative rotational alignment was assessed using low-dose bilateral CT scans.
• Bivariable and multivariable analyses were performed to identify independent predictors.

Main Results:

• Thirty-nine percent of rotational malalignment variability was explained by a model including tibial torsion of the noninjured side, fracture side, and fracture type.
• Reduced baseline tibial torsion, right-sided TSF, and spiral fractures were associated with external rotational malalignment.
• Increased baseline tibial torsion and left-sided TSF were associated with internal rotational malalignment.

Conclusions:

• Baseline tibial torsion, fracture side, and fracture type are significant predictors of postoperative rotational malalignment after intramedullary nailing of TSF.
• A regression model incorporating these factors can help surgeons anticipate rotational differences.
• This predictive capability may guide surgical technique to minimize rotational malalignment.