Abstract

Malrotation is the most frequent consequence of operative management of the fractures of the femur, appearing in such symptoms as the impairment of ambulatory skills, pain, and the permanent limitation of functional activity. Malrotation might be explained by the etiology related to the operative techniques, morphology of fractures, and a series of other factors that encompass the severity of the fracture, the duration of the operation, and patient-specific factors. The improvement of clinical results and the decrease in the revision rates depend on the in-depth comprehension of the effects of several surgical strategies on the post-surgery occurrence of malrotation. A systematic review was conducted to assess the impact of various surgical procedures on femoral malrotation following fractures. The prevalence of malrotation ranged between 10% and 41.2%, with higher levels in complicated fractures and those that were handled on the night shift. Malrotation was found to be reduced in relation to surgical techniques and, in particular, minimally invasive nail insertion techniques. External-rotation malalignment was especially high in bilateral fractures. When there was a severe malrotation, the functional outcomes were worsened significantly, and pain and mobility were largely affected. On the other hand, minor malrotation (≤ 15) had an insignificant effect on the functions. Postoperative imaging modalities, especially computed tomography, were essential in the identification of occult malrotation, and revision surgery was often recommended in clinically significant malalignment. Key determinants affecting the rate of femoral malrotation were surgical approach, degree of fracture, and timing of operation.

Key words: Surgical approaches, femoral malrotation, fracture, influence, comprehensive review.