Objective:
Operative treatment of femoral fractures yields a predictably high union rate, but residual malrotation and leg length discrepancy remain a clinically significant problem. The aim of this study was to determine the safety and efficacy of using computerized navigation in controlling the length and rotation in femoral fracture surgery.
Design:
Prospective consecutive case series of 16 skeletally mature patients with femoral fractures undergoing surgical fixation; 14 were fixed with intramedullary nails and 2 with plates.
Setting:
An Academic Level I trauma center.
Intervention:
Computerized navigation was used to determine the length and rotation of the operated extremity as compared with the intact healthy contralateral side.
Main outcome measure:
All patients underwent postoperative computed tomography scanogram for determining the length and rotation.
Results:
All fractures healed. Mean rotational difference between the treated and nontreated sides was 3.45 degrees (range, 0–7.7 degrees). Mean length difference between the 2 extremities as calculated by the computed tomography scan was 5.83 mm (range, 0–13 mm). Additional operative time required for computerized navigation was measured in 2 of the cases and totaled ∼30–35 min/case.
Conclusion:
Computerized navigation was accurate and precise at restoring femoral length and rotation during femoral fracture fixation when the intact contralateral femur was used for reference. Further, large-scale randomized studies are required. Additionally, improvements aimed at decreasing operative time and improving user interface of these systems are recommended.
Level of evidence:
Therapeutic Level IV. See Instructions for Authors for a complete description of the levels of evidence.
