Femoral malrotation after intramedullary nailing in obese versus non-obese patients.
Abstract
OBJECTIVE: Intramedullary nailing (IMN) of obese patients with femoral fractures can
be difficult due to soft tissue considerations and overall body habitus. Complications
including malrotation can occur and have significant impact on postoperative function.
The purpose of this study was to evaluate femoral rotation after intramedullary nailing
of obese and non-obese patients to see if there was a difference in rotation, complications
and any risk factors for malrotation. MATERIALS AND METHODS: Between 2000 and 2009,
417 consecutive patients with femur fractures treated with IM nail at Level I trauma
and tertiary referral center. Of these, 335 with postoperative computed tomography
(CT) scanogram of the bilateral lower extremities were included in this study. Baseline
demographic, perioperative and postoperative femoral version calculations were included
in the dataset. Statistical analysis included chi-squared test for categorical data,
t-test for continuous data, and univariate and multivariate regression analysis. Significance
was set at p<0.05. RESULTS: Of the 417 patients with femur fractures between 2000
and 2009, 335 met criteria for this study. There were 111 patients with a BMI <25,
129 with BMI 25-29.9, and 95 patients with a BMI >30. When BMI was categorised into
3 groups (<25, 25-29.9, or 30+), none of these groups were predictive of version in
univariate or multivariate regressions. Among only obese patients (BMI 30+), BMI of
35+ was not a significant predictor of version when compared to BMI 30-34.9. There
were no significant differences in femoral version based on entry point (antegrade
vs. retrograde) in any BMI category. There were also no significant difference between
groups of patients with a DFV of >15̊ (p=0.212). CONCLUSIONS: Based on this study,
BMI did not have an effect on postoperative difference in femoral version. In fact,
in our multivariate regression analysis, BMI of over 30 was actually predictive of
significantly lower difference in femoral version. While other studies have documented
the intraoperative difficulties encountered with obese patients with femur fractures,
the outcome of femoral rotation is not affected by an increasing BMI.
Type
Journal articleSubject
BMIFemoral version
Intramedullary nail
Obesity
Outcomes level of evidence: Level III prognostic
Adult
Analysis of Variance
Body Mass Index
Bone Nails
Female
Femoral Fractures
Fracture Fixation, Intramedullary
Fracture Healing
Humans
Male
Middle Aged
Obesity
Postoperative Complications
Recovery of Function
Risk Factors
Time Factors
Tomography, X-Ray Computed
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https://hdl.handle.net/10161/15566Published Version (Please cite this version)
10.1016/j.injury.2014.02.010Publication Info
Koerner, John D; Patel, Neeraj M; Yoon, Richard S; Gage, Mark J; Donegan, Derek J;
& Liporace, Frank A (2014). Femoral malrotation after intramedullary nailing in obese versus non-obese patients.
Injury, 45(7). pp. 1095-1098. 10.1016/j.injury.2014.02.010. Retrieved from https://hdl.handle.net/10161/15566.This is constructed from limited available data and may be imprecise. To cite this
article, please review & use the official citation provided by the journal.
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Show full item recordScholars@Duke
Mark Gage
Assistant Professor of Orthopaedic Surgery
I am an orthopaedic surgeon here at Duke specializing in the care of orthopaedic trauma,
complex fractures, limb reconstruction, shoulder arthroplasty, osteomyelitis, and
post-traumatic pathology including limb deformity, fracture non-union, and arthritis.

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