Mat Rodi, Mohd Saiful Adzuwan
(2015)
Comparative study between methods of pre-operative measurement of intramedullary nail length in fracture shaft of femur.
Masters thesis, Universiti Sains Malaysia.
Abstract
Introduction
Fractures shaft of the femur are among the most common fractures encountered in
orthopaedic practice. Locked femoral intramedullary nailing is accepted as the
standard treatment of choice for most femoral shaft fractures. As most of operation
room inventory in our setup does not have a complete range of the intramedullary
nails, most surgeons estimate the size and length of the intramedullary nail preoperatively
by various methods and keep a size bigger and smaller the assessed
length for the planned surgery.
Objective
The main objective was to study the accuracy and validity of pre-operative clinical
measurement of intramedullary nail length in fracture shaft of femur. We also studied
the inter-observer reliability of each method tested.
Methodology
This research was a prospective randomized study that involved analysis of data
taken clinically as well from plain radiograph. This study was done as a clinical
assessment. One hundred and thirty patients were enrolled. Measurement of femoral
shaft was performed by using three different methods, which were tested by three
investigators from different level of medical background. Method 1 was
measurement taken from the tip of greater trochanter to the lateral knee joint line of
the opposite limb minus 2 centimeters (standard AO), Method 2 was measurement
taken from the tip of the greater trochanter to the upper pole of patella on the opposite limb (alternative AO) and Method 3 was measurement taken from the tip of
the olecranon process to the tip of the little finger on any side (the “tip-to-tip”
method).
Results
Analysis showed that there were significant differences in inter-observer variability in
the measurement taken using Method 1 (p = 0.0001) and Method 2 (p = 0.0001) but
not in Method 3 (p = 0.763). All methods were well correlated with radiology
measurements. The average length of measurement for Method 3 were 1.7 cm
longer in female patients and 2.5 cm longer in male patients than average length of
measurement by radiograph.
Conclusions
Method 3 is valid and can be applied in clinical practice with accuracy by subtracting 1.7 cm from the measurement in a female patient and 2.5 cm from the measurement in a male patient. It also has significant inter-observer reliability. It is simple to perform, radiation-free and can be applied in a patient with bilateral femur fractures.
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