ArticleEuropean journal of trauma and emergency surgery : official publication of the European Trauma Society2022
Intraoperative torsion control using the cortical step sign and diameter difference in tibial mid-shaft fractures.
Article in European journal of trauma and emergency surgery : official publication of the European Trauma Society, 2022. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 7 papers.
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Who cites it
7 citing papers in PubMed, 8 citations in OpenAlex.
- Intraoperative torsion control with radiological cortical thickness parameters in distal tibial shaft fractures: a cadaveric study.Archives of orthopaedic and trauma surgery · 2026Article
- Shape-matching-based fracture reduction aid concept exemplified on the proximal humerus-a pilot study.International journal of computer assisted radiology and surgery · 2025Article
- Comparison of software-assisted and freehand methods of rotational assessment for diaphyseal tibia fractures.European journal of orthopaedic surgery & traumatology : orthopedie traumatologie · 2025Article
- Intraoperative fluoroscopic protocol to avoid rotational malalignment after nailing of tibia shaft fractures: introduction of the 'C-Arm Rotational View (CARV)'.European journal of trauma and emergency surgery : official publication of the European Trauma Society · 2023Article
- Intraoperative Measurement of Tibial Rotation With Lateral Axis Views Using C-arm for Tibial Fractures.Cureus · 2023Article
- Clinical assessment of tibial torsion differences. Do we always need a computed tomography?European journal of trauma and emergency surgery : official publication of the European Trauma Society · 2022Article
- Radiographic cortical thickness parameters as predictors of rotational alignment in proximal tibial shaft fractures: a cadaveric study.BMC musculoskeletal disorders · 2021Article
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Authors and funding
8 authors at 2 institutions in 1 country.
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Abstract
aimIntramedullar nailing of tibial mid-shaft fractures is a common surgical treatment. Fracture reduction, however, remains challenging and maltorsion is a common discrepancy which aggravates functional impairment of gait and stability. The use of radiographic tools such as the cortical step sign (CSS) and the diameter difference sign (DDS) could improve fracture reduction. Therefore, the validity of the CSS and DDS was analyzed to facilitate detection of maltorsion in tibial mid-shaft fractures.
methodsTibial mid-shaft fractures were induced in human cadaveric tibiae according to the AO classification type A3. Torsional discrepancies from 0° to 30° in-/external direction were enforced after intramedullary nailing. Fluoroscopic-guided fracture reduction was assessed in two planes via analysis of the medical cortical thickness (MCT), lateral cortical thickness (LCT), tibial diameter (TD), anterior cortical thickness (ACT), posterior cortical thickness (PCT) and the transverse diameter (TD) of the proximal and distal fracture fragment.
resultsThe TD, LCT and ACT have shown a highly significant correlation to predict tibial maltorsion. While a model combining ACT, LCT, PCT and TD lateral was most suitable model to identify tibial maltorsion, a torsional discrepancy of 15°was most reliably detected with use of the TD and ACT.
conclusionThe present study has shown, that maltorsion can be reliably assessed by the CSS and DDS during fluoroscopy. Thus, torsional discrepancies in tibial mid-shaft fractures can be most reliably assessed in the lateral plane by analysis of the LCT and TD.
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