Measurement Method of Femoral Anteversion During Surgery for Trochanteric Fractures

Area of Science:

• Orthopedic Surgery
• Trauma Management
• Radiographic Measurement

Background:

• Femoral rotation differences over 15° can cause functional disturbances.
• Intraoperative indicators for femoral rotation in trochanteric fractures are lacking.
• Accurate femoral anteversion measurement is critical for optimal surgical outcomes.

Purpose of the Study:

• To validate a novel intraoperative method for measuring femoral anteversion during trochanteric fracture surgery.
• To assess the accuracy of corrected intraoperative anteversion (CIAV) compared to computed tomography anteversion (CTAV).

Main Methods:

• Prospective study of 100 patients with femoral trochanteric fractures treated with a cephalo-medullary nail.
• Direct intraoperative anteversion (DIAV) measured using the hip post axis on lateral hip images.
• DIAV converted to CIAV using a derived quick chart; accuracy compared with postoperative CTAV.

Main Results:

• Mean CTAV was 10.3°±10.4°, mean CIAV was 9.6°±9.7°, with a median difference of 3°.
• 84% of patients had CIAV-CTAV differences ≤5°.
• CIAV and CTAV showed strong correlation (r = 0.936, p < 0.001) and no significant difference (p = 0.054).

Conclusions:

• The novel method using the hip post axis provides accurate intraoperative assessment of femoral anteversion in trochanteric fractures.
• This technique demonstrates sufficient accuracy for surgical guidance, potentially improving functional outcomes.
• The method shows high agreement with CT scans, with 98% of patients within the limits of agreement.