{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,12,31]],"date-time":"2025-12-31T08:26:53Z","timestamp":1767169613389,"version":"3.48.0"},"reference-count":26,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2025,8,4]],"date-time":"2025-08-04T00:00:00Z","timestamp":1754265600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2025,8,4]],"date-time":"2025-08-04T00:00:00Z","timestamp":1754265600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"DOI":"10.13039\/100007397","name":"Charles University","doi-asserted-by":"crossref","id":[{"id":"10.13039\/100007397","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Arch Orthop Trauma Surg"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>Improper closed trochanteric fracture reduction can cause rotational malposition which can lead to serious consequences. The primary objective of this study was to assess the hypothetical threshold at which excessive rotation becomes hazardous due to a significant postoperative malrotation.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Materials and methods<\/jats:title>\n                    <jats:p>We conducted a prospective study focused on closed reduction in intramedullary nailing of trochanteric fractures (AO 31A1-3) in 100 consecutive patients and its influence on final malrotation. Immediately after the closed reduction, the rotation of affected limb was measured using a balanced goniometer and the values were compared to the postoperative CT calculation. Final femoral malrotation exceeding 15\u00b0 was considered significant. All results were statistically analyzed.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      In total we observed femoral malrotation exceeding 15\u00b0 in 33 patients (33.3%). Internal rotation was significantly more common than external rotation (31 vs. 2 patients). Intraoperative rotation up to 15\u00b0 resulted in a malrotation of 10.3% (3\/29 patients). When limb rotation on the traction table exceeded 20\u00b0, malrotation incidence increased to 51.0% (26\/51 patients), making this fixed position a risk factor for significant femoral malrotation (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.0076). General anesthesia was also associated with a significantly higher rate of malrotation compared to spinal anesthesia (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.0154), however we did not find any statistical difference in error rates based on patient BMI or physiological femoral neck ante-version.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Our findings underscore the significant risk of femoral malrotation associated with perioperative rotations beyond 20\u00b0, emphasizing the need for precise rotational control during surgery. Excessive rotation on the traction table in an attempt to achieve better fracture alignment significantly increases the risk of femoral malrotation.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1007\/s00402-025-06019-z","type":"journal-article","created":{"date-parts":[[2025,8,4]],"date-time":"2025-08-04T21:38:45Z","timestamp":1754343525000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Femoral malrotation after trochanteric fracture nailing: what is the safety zone of limb rotation during closed reduction?"],"prefix":"10.1007","volume":"145","author":[{"given":"Jakub","family":"Mal\u00e9\u0159","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Michal","family":"Buk","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Martin","family":"Michna","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Milan","family":"Hrazd\u00edra","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Radek","family":"Barto\u0161ka","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ji\u0159\u00ed","family":"Sk\u00e1la-Rosenbaum","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"297","published-online":{"date-parts":[[2025,8,4]]},"reference":[{"issue":"Suppl 2","key":"6019_CR1","doi-asserted-by":"publisher","first-page":"S36","DOI":"10.1016\/S0020-1383(16)47007-5","volume":"47","author":"C Kammerlander","year":"2016","unstructured":"Kammerlander C, Neuerburg C, Verlaan JJ, Schmoelz W, Miclau T, Larsson S (2016) The use of augmentation techniques in osteoporotic fracture fixation. Injury 47(Suppl 2):S36-43. https:\/\/doi.org\/10.1016\/S0020-1383(16)47007-5","journal-title":"Injury"},{"issue":"2","key":"6019_CR2","doi-asserted-by":"publisher","first-page":"175","DOI":"10.1016\/j.cger.2014.01.001","volume":"30","author":"SM Friedman","year":"2014","unstructured":"Friedman SM, Mendelson DA (2014) Epidemiology of fragility fractures. Clin Geriatr Med 30(2):175\u2013181. https:\/\/doi.org\/10.1016\/j.cger.2014.01.001","journal-title":"Clin Geriatr Med"},{"issue":"1","key":"6019_CR3","doi-asserted-by":"publisher","first-page":"18","DOI":"10.1007\/s198-002-8333-x","volume":"13","author":"O L\u00f6fman","year":"2002","unstructured":"L\u00f6fman O, Berglund K, Larsson L, Toss G (2002) Changes in hip fracture epidemiology: redistribution between ages, genders and fracture types. Osteoporos Int 13(1):18\u201325. https:\/\/doi.org\/10.1007\/s198-002-8333-x","journal-title":"Osteoporos Int"},{"issue":"4","key":"6019_CR4","doi-asserted-by":"publisher","first-page":"803","DOI":"10.1016\/j.injury.2017.02.022","volume":"48","author":"S Babhulkar","year":"2017","unstructured":"Babhulkar S (2017) Unstable trochanteric fractures: Issues and avoiding pitfalls. Injury 48(4):803\u2013818. https:\/\/doi.org\/10.1016\/j.injury.2017.02.022","journal-title":"Injury"},{"issue":"10","key":"6019_CR5","doi-asserted-by":"publisher","first-page":"692","DOI":"10.1007\/s00402-004-0744-8","volume":"124","author":"B Hesse","year":"2004","unstructured":"Hesse B, G\u00e4chter A (2004) Complications following the treatment of trochanteric fractures with the gamma nail. Arch Orthop Trauma Surg 124(10):692\u2013698. https:\/\/doi.org\/10.1007\/s00402-004-0744-8","journal-title":"Arch Orthop Trauma Surg"},{"issue":"2","key":"6019_CR6","doi-asserted-by":"publisher","first-page":"304","DOI":"10.1097\/TA.0b013e31829a2c43","volume":"75","author":"W Liu","year":"2013","unstructured":"Liu W, Zhou D, Liu F, Weaver MJ, Vrahas MS (2013) Mechanical complications of intertrochanteric hip fractures treated with trochanteric femoral nails. J Trauma Acute Care Surg 75(2):304\u2013310. https:\/\/doi.org\/10.1097\/TA.0b013e31829a2c43","journal-title":"J Trauma Acute Care Surg"},{"issue":"2","key":"6019_CR7","doi-asserted-by":"publisher","first-page":"329","DOI":"10.1007\/s00068-023-02404-8","volume":"50","author":"MW Robioneck","year":"2024","unstructured":"Robioneck MW, Pishnamaz M, Becker N, Bolierakis E, Hildebrand F, Horst K (2024) Development of early complications after treatment of trochanteric fractures with an intramedullary sliding hip screw in a geriatric population. Eur J Trauma Emerg Surg 50(2):329\u2013337. https:\/\/doi.org\/10.1007\/s00068-023-02404-8","journal-title":"Eur J Trauma Emerg Surg"},{"key":"6019_CR8","doi-asserted-by":"publisher","first-page":"RC05","DOI":"10.7860\/JCDR\/2018\/34130.12357","volume":"12","author":"R Annappa","year":"2018","unstructured":"Annappa R, Mittal H, Kamath S, Rai S, Suresh P, Mohammed N (2018) Rotational malalignment after intramedullary fixation of trochanteric fractures. J Clin Diagnos Res 12:RC05\u2013RC08. https:\/\/doi.org\/10.7860\/JCDR\/2018\/34130.12357","journal-title":"J Clin Diagnos Res"},{"key":"6019_CR9","doi-asserted-by":"publisher","first-page":"2196","DOI":"10.1016\/j.injury.2015.07.015","volume":"6","author":"TY Kim","year":"2015","unstructured":"Kim TY, Lee YB, Chang JD, Lee SS, Yoo JH, Chung KJ, Hwang JH (2015) Torsional malalignment, how much significant in the trochanteric fractures? Injury 6:2196\u20132200. https:\/\/doi.org\/10.1016\/j.injury.2015.07.015","journal-title":"Injury"},{"key":"6019_CR10","doi-asserted-by":"publisher","first-page":"844","DOI":"10.1016\/j.otsr.2010.05.007","volume":"6","author":"M Ramanoudjame","year":"2010","unstructured":"Ramanoudjame M, Guillon P, Dauzac C, Meunier C, Carcopino JM (2010) CT evaluation of torsional malalignment after intertrochanteric fracture fixation. Orthop Traumatol Surg Res 6:844\u2013848. https:\/\/doi.org\/10.1016\/j.otsr.2010.05.007","journal-title":"Orthop Traumatol Surg Res"},{"issue":"8","key":"6019_CR11","doi-asserted-by":"publisher","first-page":"1865","DOI":"10.1007\/s00402-021-03902-3","volume":"142","author":"J Mal\u00e9\u0159","year":"2022","unstructured":"Mal\u00e9\u0159 J, D\u017eupa V, Buk M, Michna M, Marvan J, Sk\u00e1la-Rosenbaum J (2022) CT analysis of femoral malrotation after intramedullary nailing of trochanteric fractures. Arch Orthop Trauma Surg 142(8):1865\u20131871. https:\/\/doi.org\/10.1007\/s00402-021-03902-3","journal-title":"Arch Orthop Trauma Surg"},{"issue":"9","key":"6019_CR12","doi-asserted-by":"publisher","first-page":"1535","DOI":"10.3390\/medicina60091535","volume":"60","author":"M Vavourakis","year":"2024","unstructured":"Vavourakis M, Zachariou D, Galanis A, Karampinas P, Rozis M, Sakellariou E, Vlachos C, Varsamos I, Vlamis J, Vasiliadis E, Pneumaticos S (2024) Incidence of rotational malalignment after intertrochanteric fracture intramedullary nailing: a CT-based prospective study. Medicina (Kaunas) 60(9):1535. https:\/\/doi.org\/10.3390\/medicina60091535","journal-title":"Medicina (Kaunas)"},{"issue":"8","key":"6019_CR13","doi-asserted-by":"publisher","first-page":"1115","DOI":"10.1007\/s00402-010-1210-4","volume":"131","author":"P Bretin","year":"2011","unstructured":"Bretin P, O\u2019Loughlin PF, Suero EM, Kendoff D, Ostermeier S, H\u00fcfner T, Krettek C, Citak M (2011) Influence of femoral malrotation on knee joint alignment and intra-articular contract pressures. Arch Orthop Trauma Surg 131(8):1115\u20131120. https:\/\/doi.org\/10.1007\/s00402-010-1210-4","journal-title":"Arch Orthop Trauma Surg"},{"issue":"14","key":"6019_CR14","first-page":"2020003","volume":"91","author":"L BrancaVergano","year":"2020","unstructured":"BrancaVergano L, Coviello G, Monesi M (2020) Rotational malalignment in femoral nailing: prevention, diagnosis and surgical correction. Acta Biomed 91(14):2020003","journal-title":"Acta Biomed"},{"issue":"11","key":"6019_CR15","doi-asserted-by":"publisher","first-page":"111903","DOI":"10.1016\/j.injury.2024.111903","volume":"55","author":"M Cherkaoui","year":"2024","unstructured":"Cherkaoui M, Onsea J, Thielman L, Verhofstad MHJ, Obremskey WT, Fragomen AT, Bernstein M, Tetsworth K, Metsemakers WJ (2024) Management of rotational malalignment following operative treatment of fractures of the lower extremities. Scop Rev Injury 55(11):111903. https:\/\/doi.org\/10.1016\/j.injury.2024.111903","journal-title":"Scop Rev Injury"},{"issue":"5","key":"6019_CR16","first-page":"580","volume":"76","author":"ME Kent","year":"2010","unstructured":"Kent ME, Arora A, Owen PJ, Khanduja V (2010) Assessment and correction of femoral malrotation following intramedullary nailing of the femur. Acta Orthop Belg 76(5):580\u2013584","journal-title":"Acta Orthop Belg"},{"issue":"5","key":"6019_CR17","doi-asserted-by":"publisher","first-page":"807","DOI":"10.1016\/j.knee.2018.06.008","volume":"25","author":"L Dagneaux","year":"2018","unstructured":"Dagneaux L, Allal R, Pithioux M, Chabrand P, Ollivier M, Argenson JN (2018) Femoral malrotation from diaphyseal fractures results in changes in patellofemoral alignment and higher patellofemoral stress from a finite element model study. Knee 25(5):807\u2013813. https:\/\/doi.org\/10.1016\/j.knee.2018.06.008","journal-title":"Knee"},{"issue":"3","key":"6019_CR18","doi-asserted-by":"publisher","first-page":"274","DOI":"10.1016\/j.clinbiomech.2010.11.005","volume":"26","author":"Z Gugala","year":"2011","unstructured":"Gugala Z, Qaisi YT, Hipp JA, Lindsey RW (2011) Long-term functional implications of the iatrogenic rotational malalignment of healed diaphyseal femur fractures following intramedullary nailing. Clin Biomech (Bristol, Avon) 26(3):274\u2013277. https:\/\/doi.org\/10.1016\/j.clinbiomech.2010.11.005","journal-title":"Clin Biomech (Bristol, Avon)"},{"key":"6019_CR19","doi-asserted-by":"publisher","unstructured":"Yurteri A, Mercan N, K\u0131l\u0131\u00e7 M, Temiz A, Do\u011far F, Topak D, Y\u0131ld\u0131r\u0131m A (2023) Rotational alignment after intramedullary nailing in trochanteric fractures: lateral decubitus versus supine position with fracture table. Does operative position matter?. https:\/\/doi.org\/10.21203\/rs.3.rs-3322243\/v1","DOI":"10.21203\/rs.3.rs-3322243\/v1"},{"issue":"12","key":"6019_CR20","doi-asserted-by":"publisher","DOI":"10.7759\/cureus.33110","volume":"14","author":"Y Kinami","year":"2022","unstructured":"Kinami Y, Hasei J, Fujiwara K (2022) Measurement of lag-screw anteversion with an Iphone during trochanteric fracture surgery. Cureus 14(12):e33110. https:\/\/doi.org\/10.7759\/cureus.33110","journal-title":"Cureus"},{"issue":"10","key":"6019_CR21","doi-asserted-by":"publisher","first-page":"72532","DOI":"10.7759\/cureus.72532","volume":"16","author":"Y Kinami","year":"2024","unstructured":"Kinami Y, Horita M, Fujiwara K (2024) Measurement method of femoral anteversion during surgery for trochanteric fractures. Cureus 16(10):72532. https:\/\/doi.org\/10.7759\/cureus.72532","journal-title":"Cureus"},{"issue":"16","key":"6019_CR22","doi-asserted-by":"publisher","first-page":"3332","DOI":"10.1016\/j.jbiomech.2008.09.032","volume":"41","author":"O Kessler","year":"2008","unstructured":"Kessler O, Patil S, Colwell CW Jr, D\u2019Lima DD (2008) The effect of femoral component malrotation on patellar biomechanics. J Biomech 41(16):3332\u20133339. https:\/\/doi.org\/10.1016\/j.jbiomech.2008.09.032","journal-title":"J Biomech"},{"issue":"9","key":"6019_CR23","doi-asserted-by":"publisher","first-page":"1016707","DOI":"10.3389\/fsurg.2022.1016707","volume":"6","author":"P Yuwen","year":"2023","unstructured":"Yuwen P, Sun W, Guo J, Chang W, Wei N, Wang H, Ding K, Chen W, Zhang Y (2023) Femoral-tibial contact stresses on fixed rotational femur models. Front Surg 6(9):1016707. https:\/\/doi.org\/10.3389\/fsurg.2022.1016707","journal-title":"Front Surg"},{"issue":"1","key":"6019_CR24","doi-asserted-by":"publisher","first-page":"17","DOI":"10.5435\/00124635-201101000-00003","volume":"19","author":"JD Lindsey","year":"2011","unstructured":"Lindsey JD, Krieg JC (2011) Femoral malrotation following intramedullary nail fixation. J Am Acad Orthop Surg 19(1):17\u201326. https:\/\/doi.org\/10.5435\/00124635-201101000-00003","journal-title":"J Am Acad Orthop Surg"},{"key":"6019_CR25","doi-asserted-by":"publisher","unstructured":"Pande H, Tankala M, Manibanakar N, Kumar N (2021) Incidence of rotational malalignment and its effect on functional outcome after nail osteosynthesis of unstable trochanteric fractures: a prospective cohort study. Curr Orthop Pract. https:\/\/doi.org\/10.1097\/BCO.0000000000000967. (Publish Ahead of Print)","DOI":"10.1097\/BCO.0000000000000967"},{"issue":"5","key":"6019_CR26","doi-asserted-by":"publisher","first-page":"279","DOI":"10.1097\/BOT.0000000000002790","volume":"38","author":"DV Ivanov","year":"2024","unstructured":"Ivanov DV, Welby JP, Khanna A, Barlow JD, Sems SA, Torchia ME, Yuan BJ (2024) Evaluation of intraoperative fluoroscopic techniques to estimate femoral rotation: a cadaveric study. J Orthop Trauma 38(5):279\u2013284. https:\/\/doi.org\/10.1097\/BOT.0000000000002790","journal-title":"J Orthop Trauma"}],"container-title":["Archives of Orthopaedic and Trauma Surgery"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00402-025-06019-z.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1007\/s00402-025-06019-z","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00402-025-06019-z.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,12,31]],"date-time":"2025-12-31T08:21:57Z","timestamp":1767169317000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1007\/s00402-025-06019-z"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,8,4]]},"references-count":26,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2025,12]]}},"alternative-id":["6019"],"URL":"https:\/\/doi.org\/10.1007\/s00402-025-06019-z","relation":{},"ISSN":["1434-3916"],"issn-type":[{"type":"electronic","value":"1434-3916"}],"subject":[],"published":{"date-parts":[[2025,8,4]]},"assertion":[{"value":"21 August 2024","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"22 July 2025","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"4 August 2025","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"The authors declare that they have no conflict of interest.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Conflict of interest"}},{"value":"The study protocol was approved by the Institutional Ethics Committee of University Hospital Kralovske Vinohrady.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethical approval"}},{"value":"Informed consent was obtained from all individual participants included in the study.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent to participate"}},{"value":"Informed consent was obtained from all individual participants included in the study.","order":5,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent to publish"}}],"article-number":"395"}}