Does increased fracture comminution affect femoral version after intramedullary nailing? An analysis of 307 intramedullary femoral nails

Abstract Objectives: Does degree of comminution affect femoral version after intramedullary nailing of femoral shaft fractures? Design: Retrospective. Setting: Standard of care, Level II Trauma Center, Hospital. Patients/Participants: We reviewed electronic medical records of consecutive patients from 2000 to 2009 with diaphyseal femoral shaft fractures treated with intramedullary nailing and with available early postoperative computed tomography scanograms. Four hundred seventeen patients were identified, and 307 met inclusion criteria. Intervention: Intramedullary nailing of the femur. Main Outcome Measurements: Our primary study measure, determined before data collection, was the difference in femoral version between the uninjured limb and the injured limb. Femoral version was determined on postoperative computed tomography scanograms and reviewed by a fellowship trained musculoskeletal radiologist and a senior orthopaedic surgeon. Results: Fractures were classified by an experienced orthopaedic trauma attending surgeon. OTA/AO type A fractures were the most common (51.5%), followed by type B (30.0%) and type C (18.5%). When categorized according to the Winquist system, 49.5% were type 1, 14.7% were type 2, 21.2% were type 3, and 14.7% were type 4. In univariate analysis, none of the classification systems were predictive of postoperative difference in femoral version (OTA/AO types and subtypes, OTA/AO types only, all Winquist types, and low-grade vs. high-grade Winquist; P > 0.05 for all). Subsequently, multivariate models did not yield any significant predictors. Conclusions: Increasing degree of comminution based on fracture classifications had no significant impact on obtaining acceptable femoral version after intramedullary nailing. Level of Evidence: Level III.