Intramedullary nailing of diaphyseal femur fractures secondary to gunshot wounds: Predictors of postoperative malrotation

Neeraj M. Patel, Richard S. Yoon, Matthew B. Cantlon, John D. Koerner, Derek J. Donegan, Frank A. Liporace*

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

18 Scopus citations


Objectives: The purpose of this study was to determine significant factors that may impact the postoperative differences in femoral version (DFV) and differences in femoral length (DFL) between the fixed and uninjured sides after intramedullary nailing (IMN) secondary to gunshot wounds.

Design: Retrospective data registry study.\r\n

Setting: Academic level I trauma center.\r\n

Patients: Over a 10-year period, 417 patients underwent IMN of a diaphyseal femur fracture (OTA/AO 32A-C). Of these, 57 patients sustained fractures caused by gunshots and had a postoperative computed tomographic scanogram. Main Outcome Measures: DFV and DFL. The effect of the following variables on DFV and DFL were determined through univariate and stepwise multivariate regression analyses: age, sex, body mass index, trauma fellowship-trained versus nontrauma surgeon, daytime versus nighttime surgery, antegrade versus retrograde nail insertion, use of traction, type of operating table, and AO and Winquist classifications.\r\n

Results: The mean postoperative DFV for all patients was 8.62 degrees (±6.67 degrees). Postoperative DFV greater than 15 degrees was found in 12.3% of all patients. After IMN, no significant differences in DFV were found with increasing complexity of AO/OTA or Winquist fracture classification. None of the aforementioned independent variables were significantly predictive of postoperative DFV in univariate or multivariate analyses. The mean postoperative DFL for all patients was 5.25 mm (±4.36 mm). In a multivariate model, classification as Winquist type 3 or 4 was weakly (adjusted R2 = 0.075) but significantly predictive of less DFL than categorization as type 1 or 2 (P = 0.027).\r\n

Conclusions: Although gunshot-associated femur fractures may present surgical challenges for treatment through IMN, acceptable femoral rotation and length are obtainable regardless of the fracture complexity or a variety of demographic and surgically-related variables.

Original languageEnglish (US)
Pages (from-to)711-714
Number of pages4
JournalJournal of Orthopaedic Trauma
Issue number12
StatePublished - Dec 11 2014


  • Ao/OTA
  • Femoral version
  • Femur fracture
  • Gunshot
  • Intramedullary nailing
  • Malrotation
  • Trauma
  • Winquist

ASJC Scopus subject areas

  • Surgery
  • Orthopedics and Sports Medicine


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