Correction of Torsional Deformity Following Nail Osteosynthesis of a Subtrochanteric Fracture.

Abstract

Torsional deformity is a frequent complication following nail osteosynthesis of a subtrochanteric fracture. This complication is difficult to assess intraoperatively, but can cause major functional restrictions. The authors consider that a clinical assessment should be complemented by a postoperative radiological control standardised with torsion CT. Thus, torsion deformity can be recognised immediately and easily corrected if necessary. This can help to avoid long-term damage that requires considerable surgery. The video shows details of torsion correction after a ca. 5-week old subtrochanteric femoral fracture, which had been initially treated with a femur nail. Before torsion correction, the internal torsion on the right femur was 22° and the external torsion on the left femur was 2°. Thus, the total deformation of the external torsion on the left side was 24°. We note the indication for removal of the nail, torsion correction and reosteosynthesis with long PFNA. The postoperative CT control confirmed that the torsion correction was adequate with internal torsion of 25° on the operated left side.