Navigated femoral shaft fracture treatment: current status.

Femoral malrotation is a common complication after internal fixation of a femoral shaft fracture. The only valid, objective monitoring method is computer tomography-assisted torsion measurement between the proximal and distal femur; unfortunately, this can only be carried out postoperatively. A difference of 15° compared to the contralateral femur is seen as an indication for revision. With the development of computer-assisted surgery, new possibilities for performing torsion control and correction intraoperatively has been introduced. These methods also allow for navigation-assisted definition of the optimal incision site, intramedullary access, femoral nail and interlocking. The main problem lies in the extra time of surgery, which is due to performing all the steps of the surgery navigated. The solution for this problem is "hybrid navigation", in which the surgeon can select the steps he needs from the navigation system, depending on his experience or surgical technique.

[1]  M. Gardner,et al.  Navigated femoral anteversion measurements: a new intraoperative technique. , 2008, Injury.

[2]  P Keppler,et al.  [Correcting torsion after intramedullary nailing osteosynthesis of the lower extremity]. , 1997, Der Unfallchirurg.

[3]  P. Hochstein,et al.  [Determination of torsion angle after shaft fractures of the lower extremity--clinical relevance and measurement techniques]. , 1999, Der Chirurg; Zeitschrift fur alle Gebiete der operativen Medizen.

[4]  Musa Citak,et al.  Navigated femoral nailing using noninvasive registration of the contralateral intact femur to restore anteversion. Technique and clinical use. , 2007, Journal of orthopaedic trauma.

[5]  D. Clawson,et al.  Closed intramedullary nailing of femoral fractures. A report of five hundred and twenty cases. 1984. , 1984, The Journal of bone and joint surgery. American volume.

[6]  C. Krettek,et al.  Three-dimensional measurement of femoral antetorsion: comparison to a conventional radiological method , 2010, Archives of Orthopaedic and Trauma Surgery.

[7]  N. Verdonschot,et al.  Rotational Malalignment After Intramedullary Nailing of Femoral Fractures , 2004, Journal of orthopaedic trauma.

[8]  W Strecker,et al.  [Computed tomographic torsion-angle and length measurement of the lower extremity. The methods, normal values and radiation load]. , 1992, RoFo : Fortschritte auf dem Gebiete der Rontgenstrahlen und der Nuklearmedizin.

[9]  Kristensen Kd,et al.  Degenerative arthritis of the knee secondary to fracture malunion. , 1989 .

[10]  Sigvard T. Hansen,et al.  Closed Intramedullary Nailing of Femoral Fractures , 2001 .

[11]  C. Krettek,et al.  Unreamed intramedullary nailing of femoral shaft fractures: operative technique and early clinical experience with the standard locking option. , 1996, Injury.

[12]  Z. Halata,et al.  [Antetorsion of the femur neck. A variable of the trochanter minor?]. , 1991, Der Unfallchirurg.

[13]  F. Gebhard,et al.  Posttraumatische Achsabweichungen und funktionelle Untersuchungen nach ante- bzw. retrograder Marknagelung des distalen Femurdrittels , 2005, Der Unfallchirurg.

[14]  B. Katthagen,et al.  [Femoral torsional deformities]. , 2000, Der Orthopade.

[15]  Christian Krettek,et al.  Robot-assisted fracture reduction: A preliminary study in the femur shaft , 2006, Medical and Biological Engineering and Computing.

[16]  Daniel Kendoff,et al.  A rat model for evaluating physiological responses to femoral shaft fracture reduction using a surgical robot , 2008, Journal of orthopaedic research : official publication of the Orthopaedic Research Society.

[17]  T. Terjesen,et al.  Femoral shaft fractures treated by intramedullary nailing. A follow-up study focusing on problems related to the method. , 1995, Injury.

[18]  M. C. van Joost,et al.  Malrotation after femoral shaft fractures. , 1972, Archivum chirurgicum Neerlandicum.

[19]  D. Eckhoff.  Effect of limb malrotation on malalignment and osteoarthritis. , 1994, The Orthopedic clinics of North America.

[20]  C. Krettek,et al.  A mechanical distal aiming device for distal locking in femoral nails. , 1999, Clinical orthopaedics and related research.

[21]  Shirley Dex,et al.  JR 旅客販売総合システム（マルス）における運用及び管理について , 1991 .

[22]  Kettelkamp Db,et al.  Degenerative arthritis of the knee secondary to fracture malunion. , 1988 .

[23]  M. Gardner,et al.  [Femoral nail osteosynthesis. Mechanical factors influencing the femoral antetorsion]. , 2008, Der Unfallchirurg.

[24]  Van Joost Mc,et al.  Malrotation after femoral shaft fractures. , 1972 .

[25]  D. Helfet,et al.  Orthopaedics and the Law , 2005, The Journal of the American Academy of Orthopaedic Surgeons.