CORRECTIVE OSTEOTOMIES AFTER TORSIONAL DE FORMITIES FOLLOWING INTRAMEDULLARY NAILING OF THE FEMUR AND THE TIBIA

Intraoperative control of torsion is delicate in intramedullary nailin g of femur and tibia fractures. Post-traumatic torsional deformities c ause clinical problems if the rotational 0-position, according to the neutral-0-method, cannot be attained or exceeded, The necessary precon dition for every indication and planning of corrective osteotomies is conscientious analysis of the geometry of the lower extremities by cli nical means, radiography and computed tomography. Operative procedures and techniques of corrective osteotomies in case of torsional deformi ties after intramedullary nailing are presented. Preoperatively, the i ntraindividual torsional differences in 15 patients with maltorsions o f the femur were 33 degrees (-37/+50) and in 7 patients with maltorsio ns of the tibia 23 degrees (-21/+29). Positive signs indicate external and negative signs of internal maltorsions. Postoperatively, the intr aindividual torsional differences were 6 degrees (-3/-+14) in the femo ra and 7 degrees (+3/+12) in the tibiae. Therefore, the physiological torsional tolerance of 15 degrees was respected in all 22 patients. Ad ditionally, limb lengthening was realized in 4 patients with shortenin g after intramedullary nailing of the femur. In 3 patients a one-step procedures with interposition of allogeneic cancellous bone in the ost eotomy gap was performed and in one patient continuous callus distract ion by external fixation.