• Chang Dong Han, Young Han Lee, Kyu Hyun Yang, Ick Hwan Yang, Woo Suk Lee, Yoo Jung Park, and Kwan Kyu Park.
• Department of Orthopaedic Surgery, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-gu, Seoul, Korea.
• Arch Orthop Trauma Surg. 2012 Dec 1;132(12):1747-52.

BackgroundPredicting rotation of proximal femur in femur fracture surgeries is important to prevent malrotation.ObjectiveWe aimed to prevent malrotation by developing a simple guideline that enables the prediction of proximal femur rotation using translucent 3-dimensional computed tomography (3D CT).DesignRetrospective.SettingOne tertiary general hospital in the Republic of Korea.PatientsThirty-six subjects who underwent CT angiographies for vascular evaluation.InterventionTranslucent 3D CT images were created from the CT data.Main Outcome MeasureMorphologic ratios of the great trochanter (GT) and lesser trochanter (LT) with the hip center as a basic point were measured at neutral position and at 5°, 10°, 15°, 20°, 25°, and 30° of internal rotation (IR) and external rotation (ER). The rotation angles at which the GT ratio becomes 0.5 and 0.33 and the rotation angles at which the LT ratio becomes 0.0 and 1.0 were determined to serve as guide angles.ResultsBoth the proportion of GT and LT compared with proximal femur with hip center as a reference (GT and LT ratio) gradually increased in the shift from IR to ER. At a neutral position, the GT and LT ratios were approximately 0.4 and 0.5, respectively. At 10°-15° of ER, the approximate GT and LT ratios were 0.5 and 1.0, respectively. At 30° of ER, the GT ratio exceeded 0.6, and the LT ratio exceeded 1.0. Between 10° and 15° of IR, the GT ratio decreased to approximately 0.33 and the LT ratio decreased to 0.0, which indicated that the LT was invisible.ConclusionsWe suggested practical values which might be useful as a reference in the operating room practically and hope that our findings would be helpful to prevent malrotation while performing proximal femur or femur shaft surgeries.

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