Intraoperative Radiographic Rotational Profile of the Tibia: Technique and Clinical Series

Recreating tibial torsion in patients with complex tibial fractures is an important intraoperative consideration, particularly for fractures with comminution or segmental bone loss. Failure to accurately restore tibial alignment may lead to malrotation, poor functional outcomes, and reoperation to correct rotational deformity. No consensus currently exists regarding the optimal technique for intraoperative measurement of tibial torsion in patients undergoing tibial fracture fixation. This article describes a technique using a mobile C-arm fluoroscope to intraoperatively measure torsion of the contralateral uninjured leg to guide surgical fixation of the fractured tibia. The rotational profile of the uninjured leg is produced by obtaining a perfect lateral of the knee followed by an ankle mortise view. A series of patients is also presented that demonstrates the reproducibility of the technique and demonstrates the range of tibia torsion in patients with tibia fractures.