{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,18]],"date-time":"2026-09-18T07:59:58Z","timestamp":1789718398235,"version":"4.0.1"},"reference-count":38,"publisher":"Springer Science and Business Media LLC","issue":"4","license":[{"start":{"date-parts":[[2022,2,10]],"date-time":"2022-02-10T00:00:00Z","timestamp":1644451200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2022,2,10]],"date-time":"2022-02-10T00:00:00Z","timestamp":1644451200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"name":"Medizinische Hochschule Hannover (MHH)"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Eur J Trauma Emerg Surg"],"published-print":{"date-parts":[[2022,8]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec>\n                <jats:title>Background<\/jats:title>\n                <jats:p>Tibial torsional malalignment presents a well-known complication of intramedullary nailing for tibial shaft fractures.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Purpose<\/jats:title>\n                <jats:p>Objective of this study was to investigate the ability to clinically assess tibial torsion differences. Computed Tomography (CT) was used here as the gold standard. Further, intra- and inter-observer reliability of the clinical examination, and radiological measurements were calculated.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Methods<\/jats:title>\n                <jats:p>Fifty-one patients with torsion-difference CTs, obtained for various reasons, were asked to kneel on an examination couch with free hanging feet. All patients are positioned with 90\u00b0 flexed knee and neutral ankle. A picture of the lower extremities was obtained from the back of the patient. Two blinded orthopedic surgeons were asked to look at the pictures and measure the tibial torsion with a digital goniometer, based on the axis of the femur in relation to the second ray of the foot. To determine the intra-observer variation, the torsional angles were calculated again after 4\u00a0weeks. To be able to compare values, two blinded radiologists calculated torsional differences based on computed tomography.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Results<\/jats:title>\n                <jats:p>All patients were able to be positioned for clinical assessment (<jats:italic>n<\/jats:italic>\u2009=\u200951). Clinical assessment of torsional difference revealed 4.55\u00b0\u2009\u00b1\u20096.85 for the first, respectively, 4.55\u00b0\u2009\u00b1\u20097.41 for the second investigator. The second measurement of the first investigator revealed a value of 4.57\u00b0\u2009\u00b1\u20096.9. There was a good intra-observer agreement for clinical assessment (ICC 0.993, <jats:italic>p<\/jats:italic>\u2009&lt;\u20090.001). Also, the inter-observer agreement showed a good inter-observer agreement (ICC 0.949, <jats:italic>p<\/jats:italic>\u2009&lt;\u20090.001). Evaluation of radiological inter-observer assessment could also show a good inter-observer agreement (ICC 0.922, <jats:italic>p<\/jats:italic>\u2009&lt;\u20090.001). The clinical method showed a good correlation to the CT method (0.839, <jats:italic>p<\/jats:italic>\u2009&lt;\u20090.001). Additionally, the Bland\u2013Altman plot was used to compare graphically both measurement techniques, which proved the agreement.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Conclusion<\/jats:title>\n                <jats:p>In summary, computed tomography-assisted measurement of tibial torsion and clinical assessment correlated significantly good. In addition to that, clinical measurement has a good intra- and inter-observer reliability. Clinical examination is a reliable and cost-effective tool to detect mal-torsion and should be part of the repertoire of every surgeon.<\/jats:p>\n              <\/jats:sec>","DOI":"10.1007\/s00068-022-01884-4","type":"journal-article","created":{"date-parts":[[2022,2,10]],"date-time":"2022-02-10T17:02:25Z","timestamp":1644512545000},"page":"3229-3235","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":11,"title":["Clinical assessment of tibial torsion differences. 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All authors contributed to the study conception and design. Material preparation and data collection were performed by Humam Hawi, Emmanouil Liodakis and Till Kaireit. Analysis of the results was performed by all authors. The first draft of the manuscript was written by Humam Hawi and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Conflict of interest"}}]}}