Keywords
intramedullary nailing
angular malalignment
proximal femur
fracture alignment
orthopedic surgery
How to Cite
Abstract
Background: Femoral shaft fractures, commonly resulting from high-energy trauma, are frequently managed with intramedullary (IM) nailing due to its biomechanical advantages and minimally invasive nature. Despite its efficacy, angular malalignment remains a concerning complication, particularly in proximal fractures, and can lead to functional impairment if unaddressed.
Objective: This study aimed to determine the frequency of angular malalignment in patients undergoing IM nailing for femoral shaft fractures and to identify associated clinical factors.
Methodology: A cross-sectional observational study was conducted at the Department of Orthopaedics & Spine Centre, Ghurki Trust Teaching Hospital, Lahore, from November 2024 to April 2025. Fifty-three patients aged 15 years and older who underwent antegrade or retrograde IM nailing for acute traumatic femoral shaft fractures were included. Radiographic malalignment was defined as ≥5° deviation in the coronal or sagittal plane on immediate postoperative X-rays. Two orthopedic surgeons independently assessed radiographs. Associations between malalignment and clinical variables were analyzed using Chi-square or Fisher’s exact tests.
Results: Of the 53 patients, the majority were male (86.8%) with a mean age of 33.11 years. Malalignment was observed in 3 patients (5.7%). A significant association was found between malalignment and fracture location (p = 0.012), with all cases occurring in proximal third fractures. The type of angular deformity (varus or flexion) was also significantly associated with malalignment (p < 0.001). No significant relationship was found with age, gender, side of fracture, type of nail, nail diameter, or mechanism of injury.
Conclusion: Angular malalignment following IM nailing is uncommon but significantly more likely in proximal femoral fractures. This may be due to muscular forces such as the abductors and iliopsoas causing varus and flexion deformities. Meticulous reduction techniques and the use of stable fixation methods like double-locked nails are recommended in these cases to minimize postoperative malalignment and improve outcomes.