| Objective: closed reduction and intramedullary nail fixation was one ofthe most commonly used methods of treatment of femoral fractures. However,due to the closed surgery, fracture couldn’t look straight into the resetintraoperatively, the occurrence rate of rotation malformations and angulationdeformities was high. Some reports showed that with the femoral rotationdeformity appeared femoral anteversion angle would vary, the load-bearingfemoral head and the hip stress distribution changes could cause ischemicnecrosis of femoral head traumatic arthritis, and for more than15°rotationdeformity may lead the patients to dysfunction. So, the measurement offemoral rotation can not be ignored.For clinicians and anatomist, how to measure femoral’s rotationdeformity has continued more than100years. The traditional method ofclinical judgment for femoral rotation deformity has the following three:①Power line method: With the help of the C arm X-ray machine, use pen tomark the joint center of femoral and ipsilateral ankle on the surface of skin. Ifwithout rotation deformity, the attachment of the two points can be judgedthrough the center of the knee joint, or through whether the attachment of iliacspine and the first and second toe in ipsilateral will go through the middlepoint of the scutum.②Lesser trochanter method: Put both sides of femoralcondyle at neutral position, and compare the shape of lesser trochanter of theinfected side with the healthy side. If the shape of lesser trochanter on the twosides are the same, there is no rotation; If lesser trochanters becomes maller,there is external rotation deformity in distal femur; If bigger, there is internalrotation deformity in distal femur.③Cortex "steps" and diameter differencesmethod: For femoral transection or short oblique fractures, if there is rotation, the thickness of cortex in fracture end on the two sides has slight differences.Through the C arm X-ray machine to observe perspective image, the fractureend on both sides of the bone cortex can appear "steps". However, this methodis not suitable for judging the rotation of the comminuted fracture deformities.All the three methods above depend on visual inspection, unable to measurethe angle of the rotation of the femoral deformity. The method in which canmeasure the angle of rotation of the femoral deformity and directly measurethe femoral proximal angle rotation deformity has the following two kinds:①According to the positional relation between the form of lesser trochanter andproximal femur rotation deformity, Jaarsma etc. and Zhang etc. put forwardthe method that through measuring the height and width of small rotator tomeasure the rotation angle, within the scope of internal20°and external20°atproximal femur can calculate the rotation deformity angel.②ZhangGuochuan etc, puts forward the concept of greater trochanter tilting index, theexperimental research shows that greater trochanter tilting index canaccurately reflect its relationship with rotation. Greater trochanter tilting indexcan be applied to judge the femoral rotation condition. According to the linearregression equation: proximal femoral rotation angle deformity=-22.8+73.18×the femoral greater trochanter tilting index. Currently CT scan tomeasure postoperative femoral rotation deformity after closed reduction andintramedullary nail for femoral fractures has been widely assured and appliedclinically. Murphy and Jiang Xieyuan have put forward a method of CTmeasurement of femoral anteversion angle: Postoperative patients lie on a CTscanning bed, with their two legs fixed and two feet in neutral position. Then,choose bilateral hip and bilateral femoral distal as the scanning scope to do CTaxial scan, the level of the central axis of the measured femoral neckhorizontal sextant angle-horizontal sextant angle of trailing edge tangentdouble condyle=femoral anteversion angle. To calculate the differencebetween the infected femur and healthy femur of their femoral anteversionangle, and the dip angle is the angle of femoral rotation deformity.Ultrasonic measurement of femoral rotation has a history of more than twenty years. In1990, Terjesen T used ultrasound to measure femoralanteversion angle firstly. Make the patient supine, with distal femur neutralposition, use ultrasonic to measure the femoral anteversion angle, and thencalculate the rotational deformity of femur. Ehrenstein T and David Hudson,also once used the same way to measure the rotation of the femoral deformityangle, and through the experimental study they confirmed the validity andreliability of the ultrasonic measurement of the femoral rotation. The purposeof this study was to apply ultrasonic to judge the rotation condition of femoralfracture after closed reduction and intramedullary nail fixation ofpostoperative femoral, measure the rotation of the femoral deformity, andverify the accuracy of this measurement method.Methods: From January2012to January2013there were20adultpatients of femoral fractures in middle postoperative with closed reduction andintramedullary nail fixation.10cases are man and10women. The average agewas30.5years(18~40years). All of the patients were unilateral closedfractures,14cases on the left side and6cases on the right side. According tothe AO/ASIF classification:32-A2(8cases),32-B1(4cases),32-B2(3cases),32-C2(5cases). Cases in this study inclusion criteria: no serious medicalconditions and other parts of the compound injury midway through unilateralclosed femoral fractures cases closed intramedullary nailing fixation afteroperation. Test time was5~7days after surgery. Make postoperative patientsin prone position, and apply ultrasonic to observe femur thick thread. Thehealthy leg’s femur thick line after femoral midway through the middle of alongitudinal convex shape was a straight line. When the infected femurappears postoperative femoral rotation deformity, in femoral fracture’s middlerange, the femur thick line are parallel. Through the observation of thelocation of fracture’s far and proximal end’s femur thick line to judge thefemoral rotate condition. Use ultrasonic to observe short femoral shaft, femurthick line on the display show the tip shape strong echo images. Using thisimage characteristics of femur thick line, adjust the angle of ultrasound probe,refer to a diameter of60cm are angle gauge, measure the angle of the rotation of the femoral deformity. Then, do bilateral femoral proximal and far-end CTscan, measure and calculate the femoral anteversion angle of the dip anglebetween the healthy side and infected side, and the dip angle was the rotationdeformity of femur.Results: With the application of ultrasonic measurement, the deformityfemoral rotation angle of postoperative femur on average was5.82°±3.38°(0°~13.50°), with the application of CT measurement the femoralrotation deformity angel on average was6.00°±3.72°(0°~15.80°), thecomparison had no statistically significant difference (t=0.808, P=0.429).Application of ultrasonic measurement results:14cases were of fracture ofdistal extorsion deformity, internal rotation deformity in5cases, no rotationdeformity in1case. And the direction of rotation were totally the same as theresults of CT measurement.Conclusion: Apply ultrasonic to observe femur thick line of infected side,people could accurately judge the rotating condition in the middle of shaftfemoral fracture after closed reduction and intramedullary nail fixation, andaccurately measure the rotation of the femoral deformity angle. |
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