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Intraoperative Radiographic Rotational Profile of the Tibia: Technique and Clinical Series.

Sean P Wrenn¹, Robert B Ponce, Ridge Maxson

¹Department of Orthopaedic Surgery, Vanderbilt University Medical Center, Nashville, TN.

Journal of Orthopaedic Trauma

|February 21, 2025

Summary

Accurately measuring tibial torsion during surgery for complex tibial fractures is crucial. This study presents a novel C-arm fluoroscopy technique using the uninjured leg to guide accurate rotational alignment, improving patient outcomes.

Keywords:

anatomic variation intraoperative radiograph tibial rotation tibial torsion

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Area of Science:

Orthopedic Surgery
Biomedical Engineering
Radiology

Background:

Tibial torsion is critical for proper limb alignment and function.
Malrotation after tibial fracture fixation can lead to poor outcomes and necessitate revision surgery.
Current methods for intraoperative tibial torsion assessment lack standardization.

Purpose of the Study:

To describe a reproducible C-arm fluoroscopy technique for intraoperative measurement of tibial torsion.
To establish a method for guiding surgical fixation of complex tibial fractures.
To assess the range of tibial torsion in patients with tibial fractures.

Main Methods:

A mobile C-arm fluoroscope was used to obtain imaging of the contralateral uninjured leg.
A perfect lateral view of the knee and an ankle mortise view were acquired to create a rotational profile.
The technique was applied intraoperatively to guide tibial fracture fixation.

Main Results:

The described technique allows for intraoperative measurement of tibial torsion using the uninjured limb.
The method demonstrated reproducibility in a series of patients.
The study provides data on the typical range of tibial torsion in patients with fractures.

Conclusions:

Accurate intraoperative assessment and correction of tibial torsion are vital for complex tibial fractures.
This C-arm fluoroscopy technique offers a practical solution for guiding tibial fracture fixation.
Restoring correct tibial alignment can prevent malrotation and improve functional outcomes.