Purpose: In a previous study, our group introduced a simple non-invasive method for the intraoperative control of femoral torsion during closed nailing of femoral fractures using the shape of the greater trochanter and its relation to the femoral head. The aim of this study was to verify the results of our cadaveric study and transfer them into a clinical setup. We answered the questions: How much time is needed to perform the greater trochanter-head contact point method (GT-HCP)? How long is the radiation time?
Methods: We examined 15 patients with femoral shaft fractures, to evaluate the GT-HCP method in a clinical setup. Using a standard fluoroscopic image intensifier (Ziehm, Erlangen, Germany), the greater trochanter-head contact angle was measured for both sides. All patients received a postoperative computer tomography (CT) to check the rotational malalignment. The mean of the CT results was then compared to the measurements of the GT-HCP method. The examiners performing the CT measurements were not aware of the GT-HCP results and vice versa.
Results: No statistical significance could be detected between the CT and the GT-HCP method (p = 0.853). Eleven patients had very good results (≤5°), three had good results (6-10°) and one had poor results (>10°). The mean difference between CT and GT-HCP method was 3.7 ± 3.3°, which is acceptable. The radiation dose needed for the method was not large (0.2 ± 0.1 min), and could be lowered with the gaining experience of the examiners. Similarly, the overall time needed (12.1 ± 4.9 min) for the GT-HCP method could be reduced with the experience of the team.
Conclusion: Our study showed that the GT-HCP method is a precise and not particularly time consuming method for controlling anteversion during closed femoral nailing. Further clinical trials including a larger number of patients are required to establish this method in clinical practice.