Acta Scientific Orthopaedics (ISSN: 2581-8635)

Review Article Volume 6 Issue 9

Femoral Malrotation Following Intramedullary Nailing of Femoral Shaft Fractures

Gary Ulrich1*, Kameron Kraus1 and David Rich2

1Department of Orthopedic Surgery, University of Kentucky College of Medicine, Lexington, KY, USA
2Eclipse Orthopaedics, Warsaw, IN, USA

*Corresponding Author: Gary Ulrich, Department of Orthopedic Surgery, University of Kentucky College of Medicine, Lexington, KY, USA.

Received: August 21, 2023; Published: August 29, 2023


Femoral malrotation represents one of the common causes of deformity following intramedullary nailing of femoral shaft fractures that can lead to cosmetic and functional consequences. Femoral malrotation is often underrecognized because femoral rotation is variable amongst the population and even variable within a patient comparing one’s own lower extremities. Moreover, femoral malrotation is difficult to measure. Clinical examination, ultrasonography, radiography, and computed tomography have all been described to measure femoral malrotation. In this review, we discuss the IMN complication of femoral malrotation with respect to its definition, functional significance, how to measure it, and treatment.

Keywords: Femoral Malrotation; Femoral Torsion; Intramedullary Nailing; Femoral Shaft Fractures


  1. Denisiuk M and Afsari A. “Femoral shaft fractures”. Musculoskeletal Science and Practice 39 (2019): 115-122.
  2. Mansouri-Tehrani Mohammad Masih., et al. "Evaluation of femoral malrotation after intramedullary nailing”. International Journal of Burns and Trauma5 (2021): 418.
  3. Lindsey Joshua D and James C Krieg. "Femoral malrotation following intramedullary nail fixation”. JAAOS-Journal of the American Academy of Orthopaedic Surgeons1 (2011): 17-26.
  4. Mesgarzadeh Mamed George Revesz and Akbar Bonakdarpour. "Femoral neck torsion angle measurement by computed tomography”. Journal of Computer Assisted Tomography5 (1987): 799-803.
  5. Reikeras Olav., et al. "Femoral neck angles: a specimen study with special regard to bilateral differences”. Acta Orthopaedica Scandinavica5 (1982): 775-779.
  6. Vergano Luigi Branca Gianluca Coviello and Mauro Monesi. "Rotational malalignment in femoral nailing: prevention, diagnosis and surgical correction”. Acta Bio Medica: Atenei Parmensis14 (2020).
  7. Ricci William M., et al. "Retrograde versus antegrade nailing of femoral shaft fractures”. Journal of Orthopaedic Trauma3 (2001): 161-169.
  8. Jaarsma RL., et al. "Rotational malalignment after intramedullary nailing of femoral fractures”. Journal of Orthopaedic trauma7 (2004): 403-409.
  9. Tornetta Paul George Ritz and Alan Kantor. "Femoral torsion after interlocked nailing of unstable femoral fractures”. Journal of Trauma and Acute Care Surgery2 (1995): 213-219.
  10. Kent Matthew E., et al. "Assessment and correction of femoral malrotation following intramedullary nailing of the femur”. Acta Orthopaedica Belgica 5 (2010): 580-584.
  11. Gugenheim Joseph J., et al. "The effects of femoral shaft malrotation on lower extremity anatomy”. Journal of Orthopaedic trauma10 (2004): 658-664.
  12. Karaman Ozgur., et al. "Rotational malalignment after closed intramedullary nailing of femoral shaft fractures and its influence on daily life”. European Journal of Orthopaedic Surgery and Traumatology24 (2014): 1243-1247.
  13. Yildirim Ahmet Ozgur., et al. "The effect of rotational deformity on patellofemoral parameters following the treatment of femoral shaft fracture”. Archives of Orthopaedic and Trauma Surgery133 (2013): 641-648.
  14. Braten, Martinus., et al. "Torsional deformity after intramedullary nailing of femoral shaft fractures. Measurement of anteversion angles in 110 patients”. The Journal of Bone and Joint Surgery British Volume5 (1993): 799-803.
  15. Gugala Zbigniew., et al. "Long-term functional implications of the iatrogenic rotational malalignment of healed diaphyseal femur fractures following intramedullary nailing”. Clinical Biomechanics3 (2011): 274-277.
  16. Jaarsma RL., et al. "Compensation for rotational malalignment after intramedullary nailing for femoral shaft fractures: an analysis by plantar pressure measurements during gait”. Injury12 (2004): 1270-1278.
  17. Lee Thay Q., et al. "The influence of fixed rotational deformities of the femur on the patellofemoral contact pressures in human cadaver knees”. Clinical Orthopaedics and Related Research®302 (1994): 69-74.
  18. Ito Ikue., et al. "Differences between the Craig’s test and computed tomography in measuring femoral anteversion in patients with anterior cruciate ligament injuries”. Journal of physical therapy science6 (2020): 365.
  19. Uding Alexandria., et al. "Clinical tests to determine femoral version category in people with chronic hip joint pain and asymptomatic controls”. Musculoskeletal Science and Practice39 (2019): 115-122.
  20. Jaarsma, Ruurd Lukas, and A. Van Kampen. "Rotational malalignment after fractures of the femur”. The Journal of Bone and Joint Surgery. British volume8 (2004): 1100-1104.
  21. Terjesen Terje., et al. "Femoral anteversion in adolescents and adults measured by ultrasound”. Clinical Orthopaedics and Related Research (1976-2007)256 (1990): 274-279.
  22. Ehrenstein T., et al. "A new ultrasound-based method for the assessment of torsional differences following closed intramedullary nailing of femoral fractures”. Skeletal radiology28 (1999): 336-341.
  23. Langer Jakub S., et al. "The cortical step sign as a tool for assessing and correcting rotational deformity in femoral shaft fractures”. Journal of Orthopaedic Trauma2 (2010): 82-88.
  24. Deshmukh RG., et al. "A technique to obtain correct rotational alignment during closed locked intramedullary nailing of the femur”. Injury3 (1998): 207-210.
  25. Bråten M., et al. "The role of fluoroscopy in avoiding rotational deformity of treated femoral shaft fractures: an anatomical and clinical study”. Injury5 (2000): 311-315.
  26. Jeanmart Louis., et al. "Computer tomography of neck, chest, spine, and limbs”. Principles of Computerized Tomographic Imaging (1983).
  27. Dugdale Thomas W., et al. "The use of computed tomographic scan to assess femoral malrotation after intramedullary nailing: a case report”. Clinical Orthopaedics and Related Research279 (1992): 258-262.
  28. Jaarsma RL., et al. "Computed tomography determined femoral torsion is not accurate”. Archives of orthopaedic and trauma surgery124 (2004): 552-554.
  29. Piper Kalman., et al. "Correcting rotational deformity following femoral nailing”. Injury6 (2009): 660-662.


Citation: Gary Ulrich., et al. “Femoral Malrotation Following Intramedullary Nailing of Femoral Shaft Fractures". Acta Scientific Orthopaedics 6.9 (2023): 85-90.


Copyright: © 2023 Gary Ulrich., et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.


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