{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,24]],"date-time":"2026-09-24T20:33:57Z","timestamp":1790282037883,"version":"4.1.0"},"reference-count":27,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2025,6,23]],"date-time":"2025-06-23T00:00:00Z","timestamp":1750636800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Surg."],"abstract":"<jats:sec><jats:title>Objective<\/jats:title><jats:p>To quantify rotational displacement following intramedullary nail fixation for intertrochanteric femoral fractures using three-dimensional (3D) CT imaging, analyze associated risk factors, and evaluate its clinical significance.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>A total of 210 patients who underwent intramedullary nail fixation for intertrochanteric femoral fractures between 2020 and 2022 were included. All patients received postoperative 3D CT scans and were followed for at least 1 year. The range of postoperative femoral anteversion on the affected side was measured, and its correlation with risk factors was analyzed.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Among the 210 participants: six patients exhibited anteversion changes exceeding 15\u00b0; seven patients had anteversion changes between 10\u00b0 and 15\u00b0; forty-three patients showed reduced anteversion (indicating increased external rotation of the affected limb), ranging from \u22121\u00b0 to \u221214\u00b0, with a mean of \u22122.58\u00b0; in 103 patients, anteversion increased postoperatively, ranging from 1\u00b0 to 22\u00b0, with a mean of 3.90\u00b0; sixty-four patients achieved restoration of normal anteversion. Single-nail fixation, poor reduction quality, medial cortical defects, <jats:italic>T<\/jats:italic>-score\u2009\u2264\u2009\u22122.5, Singh's index (\u2160\u2013\u2162), lateral wall thickness, and insufficient tip-apex distance (TAD) were identified as the primary factors contributing to rotational displacement exceeding 3\u00b0. At the 1-year follow-up, patients with smaller rotational displacement demonstrated better functional recovery. The multivariate logistic regression analysis demonstrated that several factors showed significant correlations with rotational displacement of fracture fragments after intramedullary nail fixation, including the severity of medial cortical defects, presence of medial cortical disruption, <jats:italic>T<\/jats:italic>-scores\u2009\u2264\u2009\u22122.5, low-grade Singh's index classifications (I\u2013III), diminished lateral wall thickness, inadequate TAD, Visual Analog Scale (VAS), and the Harris Hip Score (HHS).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Bone rotation and displacement are frequently observed following intramedullary nail fixation for intertrochanteric fractures. Numerous risk factors are closely associated with these complications. Therefore, meticulous attention to surgical technique is essential to minimize complications and optimize outcomes.<\/jats:p><\/jats:sec>","DOI":"10.3389\/fsurg.2025.1576336","type":"journal-article","created":{"date-parts":[[2025,6,23]],"date-time":"2025-06-23T05:21:46Z","timestamp":1750656106000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":2,"title":["Rotational changes and associated risk factors following intramedullary nail fixation for intertrochanteric femoral fractures in elderly patients"],"prefix":"10.3389","volume":"12","author":[{"given":"Chao","family":"Han","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xiaodan","family":"Li","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zhe","family":"Han","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Qiang","family":"Dong","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2025,6,23]]},"reference":[{"key":"B1","article-title":"National hip fracture database annual report","year":""},{"key":"B2","doi-asserted-by":"publisher","first-page":"1908","DOI":"10.3390\/jpm12111908","article-title":"What is the best treatment choice for concomitant ipsilateral femoral neck and intertrochanteric fracture? A retrospective comparative analysis of 115 consecutive patients","volume":"12","author":"Kim","year":"2022","journal-title":"J Pers Med"},{"key":"B3","doi-asserted-by":"publisher","first-page":"1160","DOI":"10.1016\/j.injury.2021.12.048","article-title":"Quality of fracture reduction is associated with patient survival at one year, but not 30 days, following trochanteric hip fracture fixation. A retrospective cohort study","volume":"53","author":"Macdonald","year":"2022","journal-title":"Injury"},{"key":"B4","doi-asserted-by":"publisher","first-page":"31","DOI":"10.1007\/s00402-003-0586-9","article-title":"Intramedullary fixation of pertrochanteric hip fractures with the short AO-ASIF proximal femoral nail","volume":"124","author":"Fogagnolo","year":"2004","journal-title":"Arch Orthop Trauma Surg"},{"key":"B5","doi-asserted-by":"publisher","first-page":"844","DOI":"10.1016\/j.otsr.2010.05.007","article-title":"CT evaluation of torsional malalignment after intertrochanteric fracture fixation","volume":"96","author":"Ramanoudjame","year":"2010","journal-title":"Orthop Traumatol Surg Res"},{"key":"B6","doi-asserted-by":"publisher","first-page":"2196","DOI":"10.1016\/j.injury.2015.07.015","article-title":"Torsional malalignment, how much significant in the trochanteric fractures?","volume":"46","author":"Kim","year":"2015","journal-title":"Injury"},{"key":"B7","doi-asserted-by":"publisher","first-page":"1243","DOI":"10.1007\/s00590-013-1289-8","article-title":"Rotational malalignment after closed intramedullary nailing of femoral shaft fractures and its influence on daily life","volume":"24","author":"Karaman","year":"2014","journal-title":"Eur J Orthop Surg Traumatol"},{"key":"B8","doi-asserted-by":"publisher","first-page":"311","DOI":"10.1016\/s0020-1383(99)00299-5","article-title":"The role of fluoroscopy in avoiding rotational deformity of treated femoral shaft fractures: an anatomical and clinical study","volume":"31","author":"Br\u00e5ten","year":"2000","journal-title":"Injury"},{"key":"B9","doi-asserted-by":"publisher","first-page":"344","DOI":"10.1016\/j.jclinepi.2007.11.008","article-title":"The strengthening the reporting of observational studies in epidemiology (STROBE) statement: guidelines for reporting observational studies","volume":"61","author":"von Elm","year":"2008","journal-title":"J Clin Epidemiol"},{"key":"B10","doi-asserted-by":"publisher","first-page":"1006","DOI":"10.1016\/j.injury.2014.02.007","article-title":"Hook leverage technique for reduction of intertrochanteric fracture","volume":"45","author":"Kim","year":"2014","journal-title":"Injury"},{"key":"B11","doi-asserted-by":"publisher","first-page":"961","DOI":"10.1016\/j.injury.2011.08.013","article-title":"Intramedullary nailing of trochanteric fractures\u2013operative technical tips","volume":"43","author":"Aktselis","year":"2012","journal-title":"Injury"},{"key":"B12","doi-asserted-by":"publisher","first-page":"1058","DOI":"10.2106\/00004623-199507000-00012","article-title":"The value of the tip-apex distance in predicting failure of fixation of peritrochanteric fractures of the hip","volume":"77","author":"Baumgaertner","year":"1995","journal-title":"J Bone Joint Surg Am"},{"key":"B13","doi-asserted-by":"publisher","first-page":"183","DOI":"10.1007\/s00264-017-3623-y","article-title":"Anteromedial cortical support reduction in unstable pertrochanteric fractures: a comparison of intra-operative fluoroscopy and post-operative three dimensional computerised tomography reconstruction","volume":"42","author":"Chang","year":"2018","journal-title":"Int Orthop"},{"key":"B14","doi-asserted-by":"publisher","first-page":"1008","DOI":"10.2106\/JBJS.23.01023","article-title":"Anteromedial cortical support in reduction of trochanteric hip fractures: from definition to application","volume":"106","author":"Mao","year":"2024","journal-title":"J Bone Joint Surg Am"},{"key":"B15","doi-asserted-by":"publisher","first-page":"1134","DOI":"10.1302\/0301-620X.95B8.31495","article-title":"Lateral femoral wall thickness. A reliable predictor of post-operative lateral wall fracture in intertrochanteric fractures","author":"Hsu","year":"2013","journal-title":"Bone Joint J"},{"key":"B16","doi-asserted-by":"publisher","first-page":"152","DOI":"10.1016\/j.ejrad.2008.03.019","article-title":"Evaluation of singh index for assessment of osteoporosis using digital radiography","volume":"71","author":"Hauschild","year":"2009","journal-title":"Eur J Radiol"},{"key":"B17","first-page":"S79","article-title":"Modified singh index in diagnosing femoral neck osteoporosis","volume":"94","author":"Soontrapa","year":"2011","journal-title":"J Med Assoc Thai"},{"key":"B18","doi-asserted-by":"publisher","first-page":"232","DOI":"10.18535\/jmscr\/v8i6.42","article-title":"Singhs index assessment in patients having sustained hip fractures","volume":"8","author":"Ramanujam","year":"2020","journal-title":"J Med Sci Clin Res"},{"key":"B19","doi-asserted-by":"publisher","first-page":"737","DOI":"10.2106\/00004623-196951040-00012","article-title":"Traumatic arthritis of the hip after dislocation and acetabular fractures: treatment by mold arthroplasty. An end-result study using a new method of result evaluation","volume":"51","author":"Harris","year":"1969","journal-title":"J Bone Joint Surg Am"},{"key":"B20","doi-asserted-by":"publisher","first-page":"1747","DOI":"10.1007\/s00402-012-1609-1","article-title":"Predicting proximal femur rotation by morphological analyses using translucent 3-dimensional computed tomography","volume":"132","author":"Han","year":"2012","journal-title":"Arch Orthop Trauma Surg"},{"key":"B21","doi-asserted-by":"publisher","first-page":"584","DOI":"10.1097\/JCMA.0000000000000042","article-title":"Radiographic risk factors for predicting failure of geriatric intertrochanteric fracture treatment with a cephalomedullary nail","volume":"82","author":"Hsu","year":"2019","journal-title":"J Chin Med Assoc"},{"key":"B22","doi-asserted-by":"publisher","first-page":"792","DOI":"10.1016\/j.injury.2006.12.002","article-title":"Significance of hip rotation on measurement of \u2018tip apex distance\u2019 during fixation of extracapsular proximal femoral fractures","volume":"38","author":"Kumar","year":"2007","journal-title":"Injury"},{"key":"B23","doi-asserted-by":"publisher","first-page":"1342","DOI":"10.1016\/j.injury.2011.06.004","article-title":"Factors influencing neck anteversion during femoral nailing: a retrospective analysis of 220 torsion-difference CTs","volume":"42","author":"Liodakis","year":"2011","journal-title":"Injury"},{"key":"B24","doi-asserted-by":"publisher","first-page":"403","DOI":"10.1097\/00005131-200408000-00002","article-title":"Rotational malalignment after intramedullary nailing of femoral fractures","volume":"18","author":"Jaarsma","year":"2004","journal-title":"J Orthop Trauma"},{"key":"B25","doi-asserted-by":"publisher","first-page":"213","DOI":"10.1097\/00005373-199502000-00011","article-title":"Femoral torsion after interlocked nailing of unstable femoral fractures","volume":"38","author":"Tornetta","year":"1995","journal-title":"J Trauma"},{"key":"B26","doi-asserted-by":"publisher","first-page":"19939","DOI":"10.1038\/s41598-022-24177-7","article-title":"An innovative scoring system for predicting an excellent harris hip score after proximal femoral nail anti-rotation in elderly patients with intertrochanteric fracture","volume":"12","author":"Phruetthiphat","year":"2022","journal-title":"Sci Rep"},{"key":"B27","doi-asserted-by":"publisher","first-page":"176","DOI":"10.1016\/j.injury.2007.06.008","article-title":"Femoral fracture malrotation caused by freehand versus navigated distal interlocking","volume":"39","author":"Gardner","year":"2008","journal-title":"Injury"}],"container-title":["Frontiers in Surgery"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fsurg.2025.1576336\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,6,23]],"date-time":"2025-06-23T05:21:46Z","timestamp":1750656106000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fsurg.2025.1576336\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,6,23]]},"references-count":27,"alternative-id":["10.3389\/fsurg.2025.1576336"],"URL":"https:\/\/doi.org\/10.3389\/fsurg.2025.1576336","relation":{},"ISSN":["2296-875X"],"issn-type":[{"value":"2296-875X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,6,23]]},"article-number":"1576336"}}