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Krettek Christian M.D.; Miclau, Theodore; Miclau, Theodore M.D.; Bastian, O Grnün L.; Tscherne, Harald M.D.
Techniques in Orthopaedics: September 1999
Minimally Invasive Orthopaedics: Tips and Pearls: PDF Only


To limit the amount of soft-tissue elevation at the fracture site, indirect reduction techniques have been developed to treat different types of femoral and tibial fractures. However, these techniques do not allow for direct open anatomic reduction of extra-articular fracture fragments, making the intraoperative assessment of correct frontal and sagittal plane axial alignment, length, and rotation difficult. Failure to recognize malalignment during surgery may result in the need for future correction, which becomes more difficult with time. Although several clinical and radiographic techniques to assess limb alignment have been described, including conventional radiographic methods (tele- and orthoradiography), computed tomography, and magnetic resonance imaging, many of these techniques are not available intraoperatively. This technical note describes simple and effective techniques that can be used intraoperatively to determine limb alignment. These include the following: the radiographic “cable technique” for the evaluation of frontal plane alignment; the clinical “hyperextension test” and radiographic “Blumensaat's line,” “recurvatum sign,” and “tibial plateau sign” for the determination of sagittal plane alignment; the radiographic “meter-stick technique” for the analysis of length; and the clinical “hip rotation test” and radiographic “lesser trochanter shape sign,” “cortical step sign,” and “diameter difference sign” for the determination of rotation. For each of these methods, the basic principles, techniques, benefits, and limitations are described..

© 1999 Lippincott Williams & Wilkins, Inc.