[Treatment of rotational malalignment of the lower leg].

BACKGROUND: Rotational malalignment after intramedullary nailing of tibial shaft fractures is not uncommon. In-toeing and out-toeing conditions in children are often the reason for orthopedic and traumatological medical consultation.

OBJECTIVE: Evaluation of diagnostic modalities and therapeutic options for rotational malalignment in relationship to the patient's age. Surgical indications and efficacy of specific surgical techniques.

MATERIAL AND METHODS: Systematic literature search in the German Institute for Medical Documentation and Information (DIMDI) and MEDLINE and evaluation of the currently published articles.

RESULTS: In adults computed tomography (CT) scanning is the gold standard for measuring the rotational alignment of the lower leg. To avoid exposure to ionizing radiation, magnetic resonance imaging (MRI) is currently the preferred modality in children and adolescents. The indications for corrective osteotomy are dependent on the functional complaints as well as the rotation angle measured by CT or MRI. Presently, there is no published study which demonstrates a correlation between rotation of the lower leg and the development of arthrosis in the knee or ankle joint. When a rotational osteotomy above the tibial tubercle is performed, correction of the rotation and the distance between the tibial tuberosity and the trochlear groove (TT-TG) and therefore patellofemoral imbalance can be effectively treated. Treatment of rotational malalignment after tibial shaft fractures is performed by diaphyseal osteotomy with intramedullary nail stabilization. In children, supramalleolar rotational osteotomy with subsequent locking plate osteosynthesis or stabilization using external fixation is performed for torsion correction.

CONCLUSION: If there is a suspicion of rotational malalignment in the lower leg, a CT scan can be performed in adults and MRI in children and adolescents. Surgical indications for corrective osteotomy are dependent on functional complaints as well as the CT and MRI measurements. The CT and MRI reference values are only published according to the method of Waidelich et al. and Jend et al.