Femurschaftfraktur

Femoral malrotation is a frequent malpositioning problem following femoral nail osteosynthesis (17%–34%). The only valid objective monitoring method is computer tomography-assisted torsion measurement between the proximal and distal femur; however, this can only be carried out postoperatively, thereby possibly necessitating a second surgical intervention. A discrepancy of 15° compared to the opposite side is seen as requiring revision. In recent years, navigation-assisted modules have been developed, which make intraoperative assessment and correction of femoral rotation discrepancies possible. These modules also make navigation-assisted definition of the optimal incision, navigation-assisted intramedullary opening, navigation of the femoral nail and navigation-assisted interlocking possible. The main problem lies in the extra workflow, which currently involves an unacceptably extended operating time. In addition to ergonomic advances and individualisation of procedures, the operator should reconsider the use of“hybrid navigation”, whereby only those navigation-assisted tasks deemed necessary by the individual operator are carried out.