Original Article

Minimizing Leg Length Discrepancy After Intramedullary Nailing of Comminuted Femoral Shaft Fractures: A Quality Improvement Initiative Using the Scout Computed Tomography Scanogram

Gheraibeh, Petra MD; Vaidya, Rahul MD, FRCSc; Hudson, Ian DO, MPH; Meehan, Robert MD; Tonnos, Frederick DO; Sethi, Anil MD

Author Information

Detroit Medical Center/Wayne State University, 9B University Health Center, Detroit Receiving Hospital, Detroit, MI.

Reprints: Petra Gheraibeh Gheraibeh, MD, Detroit Medical Center/Wayne State University, 9B University Health Center, Detroit Receiving Hospital, 4201 St. Antoine boulevard, Detroit, MI 48201 (e-mail: [email protected]).

No Funding was received in the production of this paper or as a grant for this publication. R. Vaidya—European Spine Journal: Editorial or governing board—JOT editorial Board—Smith & Nephew: IP royalties, paid Speaker—Smith and Nephew Institutional Research Grant Funding—Depuy Synthes: IP royalties—AO Foundation Paid Speaker. F. Tonnos: Stock or stock Options Synthes: Paid presenter or speaker AO Foundation. The remaining authors report no conflict of interest.

Presented at the Annual Meeting of the Orthopaedic Trauma Association, October 16–18, 2014, Tampa, FL.

Journal of Orthopaedic Trauma 32(5):p 256-262, May 2018. | DOI: 10.1097/BOT.0000000000001135

Abstract

Objectives:

To prevent leg length discrepancy (LLD) after locked femoral nailing in patients with comminuted femoral shaft fractures.

Design:

Prospective consecutive case series aimed at quality improvement.

Setting:

Level 1 Trauma Center

Patients:

Ninety-eight consecutive patients with a comminuted femoral shaft fracture underwent statically locked intramedullary nailing, with a focused attempt at minimizing LLD during surgery.

Intervention:

A computed tomography scanogram of both legs was performed on postoperative day 1 to assess for residual LLD. Patients were offered the option to have LLD >1.5 cm corrected before discharge.

Main Outcome Measure:

LLD >1.5 cm.

Results:

Twenty-one patients (21.4%) were found to have an LLD >1.5 cm. An LLD >1.5 cm occurred in 10/55 (18%) antegrade nail patients and 11/43 (26%) retrograde nail patients (P = 0.27). No difference was noted based on the mechanism of injury, surgeon training and OTA/AO type B versus C injury. Ninety of 98 patients left with <1.5 cm LLD, 13/21 had a correction all to ≤0.6 cm, and 8 decided to accept the LLD and declined early correction.

Conclusions:

No patient left the hospital with an LLD >1.5 cm after locked intramedullary nailing for a comminuted femoral shaft fracture without being informed and the option of early correction. We recommend using a full-length computed tomography scanogram after IM nailing of comminuted femur fractures to prevent iatrogenic LLD.

Level of Evidence:

Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.

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Minimizing Leg Length Discrepancy After Intramedullary Nailing of Comminuted Femoral Shaft Fractures: A Quality Improvement Initiative Using the Scout Computed Tomography Scanogram