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77 patients with previous intramedullary nailing of the femur underwent detailed clinical and roentgenographical examination designed to show the frequency and extent of malrotation following this type of osteosynthesis. In 29% of the cases, more than 10 degrees of torsion deviation was detected on the roentgenogram using the Rippstein technique. An average outward rotation of three degrees was found after nailing. Most of the cases of malrotation occurred after fractures involving the proximal or distal third of the femoral shaft, or when there were more than two large fragments. Transverse and short oblique fractures of the mid-shaft showed superior results. Additional causes of malrotation included the nail being too thin or intraoperative fixation of the fragments occurring in the wrong torsional position. Torsion deviations were the same after using Küntscher- or AO-nails.
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