Tibial Malrotation after Intramedullary Locked Tibia Nailing and its Computed Tomography-Based Assessment

Objectives To assess the incidence and degree of malrotation of tibia after fixation with intramedullary nail for tibial shaft fractures and its measurement by computed tomography (CT). The study also aims to assess the value of CT-based torsion angle in such cases. Material and Methods In this prospective study, fifty patients with closed/open fracture of tibia shaft (proximal 1/3, middle 1/3 or distal 1/3) with or without fracture of fibula were chosen and operated with closed/open reduction internal fixation with reamed intramedullary locked nail. Torsion angle calculated by post-operative CT and revision done for selected cases when tibial malrotation was more than 10 degrees than the control (normal side). Results The range of malreduction was from 43 degrees of external rotation to 12 degrees internal rotation. 15 of the 50 (30%) tibia operated showed malrotation and 5 (10%) were above 20 degrees. The repetition of torsion angle showed a variation of 3.2 to 4.3 degrees. Some injury patterns showed more malrotation than the others. Conclusion Assessment of tibial malrotation following intramedullary nailing has shown higher incidence of malalignment than previously reported in the literature. CT-based torsion angle calculation can be used as a reliable indicator of malrotation.