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The Intermalleolar Method for Intraoperative Rotational Assessment of the Tibia-A Prospective Clinical Validation

Michael S Roberts¹, Jordan P Conroy¹, Michael DeSarno²

¹Department of Orthopaedics and Rehabilitation, Larner College of Medicine at The University of Vermont, Burlington, VT; and.

Journal of Orthopaedic Trauma

|June 5, 2024

Summary

The intermalleolar method accurately measures tibial rotation during surgery for tibial shaft fractures, with results comparable to CT scans. This technique can help prevent rotational malalignment in patients receiving intramedullary nails.

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Area of Science:

Orthopedic surgery
Medical imaging
Fracture management

Background:

Tibial shaft fractures often require intramedullary nail fixation.
Accurate assessment of tibial rotation is crucial for optimal surgical outcomes.
Intraoperative methods for assessing tibial rotation are needed to guide fixation.

Purpose of the Study:

To evaluate the accuracy of the intermalleolar method for intraoperative tibial rotation assessment.
To compare the intermalleolar method with computed tomography (CT) as the gold standard.
To determine the clinical utility of the intermalleolar method in tibial fracture fixation.

Main Methods:

Prospective cohort study involving adult patients with tibial shaft fractures.
Intraoperative tibial rotation measured using the intermalleolar method.
Postoperative comparison with bilateral low-dose lower extremity rotational CT scans.
Analysis by four blinded observers to determine rotational differences.

Main Results:

The intermalleolar method showed a mean absolute rotational difference of 5.1 degrees compared to CT.
Ninety percent of measurements were within 10 degrees of CT.
One hundred percent of measurements were within 15 degrees of CT.
No patients required revision surgery for malrotation.

Conclusions:

The intermalleolar method is an accurate tool for intraoperative tibial rotation assessment.
Measurements are consistently within 10 degrees of CT, supporting its clinical use.
This method can aid in intraoperative rotational correction during tibial fracture fixation.