Functional outcome of rotational malalignment of tibia following closed intramedullary nail fixation

Author(s): Dr. Sunilkumar PC and Dr. Sachin NC

Abstract: Background and Objective: Malrotation is defined as a tibia torsional difference of greater than 10° (range 5–15°) compared to the unaffected limb. Common complication associated with tibia nailing procedure is tibial malunion which may lead to gait (in toeing gait and other) abnormalities, mechanical pain and early secondary osteoarthritis. Our study is focus on the functional outcome of tibial malrotation post tibia nailing.
Material and Method: Progressive Cohort study Patients of K.R HOSPITAL going to undergo surgical treatment of fracture of diaphysis and metadiaphysis of tibia. A study population for our clinical study was 40 cases in the duration between Sep 2019 and Sep 2020. Postoperative tibial torsion is assessed by Thigh foot angle assessment and plumb line alignment of leg methods. 6months and 1 year follow up outcome assessed under lower extremity functional scoring.
Result: out of 40 cases 12 cases found to have malrotation under clinical method in post tvlosed ibia nailing. Incidence of 30 % (mean =7.8 0 SD = +/- 5.2) of malrotation more than 10 0 tibial torsion in our study under Thigh foot angle assessment. All the patient surgery conducted in figure 4 position. We did follow on 6 months and 1 year post surgery. Functional Assessment done conducted using lower extremity functional score found to have mean= 70 (SD=+/-1.6) in 6 month follow up and 69(SD=+/-2.2) 1year among malrotation tibial (torsion more than 100) whereas 73 (SD = +/-2.1) in 6 month follow up and 72(SD=+/-2.2) in one year follow up in less than 10o tibial torsion. Tibial malrotation in distal 1/3 more compared to other level of tibia fracture with incidence 66 % (SD = +/- 4.3) with average lower extremity score is 70 in 6 months and 67(SD = +/-1.6) in 1 year follow up.
Conclusion: Our study show there is no significant change in functional outcome among the tibial malrotation and normal rotation alignment in post tibial nailing in 6 month and 1 year follow up. Our study suggests of need further long study for better understand in the functional outcome among the malrotation. There is significant decline in functional outcome among the malrotation of distal 1/3 fracture patients.

DOI: https://doi.org/10.22271/ortho.2022.v8.i1f.3047