Mobile application-based assessment of rotational changes after surgical treatment for pediatric femoral shaft fracture : A retrospective observational study
4 affiliations
- 1Department of Orthopedic Surgery, Jeonbuk National University Hospital, Jeonju, Jeonbuk, Republic of Korea
- 2Department of Biochemistry, Jeonbuk National University Medical School, Research Institute of Clinical Medicine of Jeonbuk National University-Biomedical Research Institute of Jeonbuk National University Hospital, Jeonju, Republic of Korea
- 3Shiley Center for Orthopaedic Research and Education at Scripps Clinic, San Diego, CA
- 4Department of Orthopedic Surgery, Jeonbuk National University Medical School, Research Institute of Clinical Medicine of Jeonbuk National University-Biomedical Research Institute of Jeonbuk National University Hospital, Jeonju, Republic of Korea.
Abstract
Although rotational changes after fixation of pediatric femoral shaft fractures are an important concern, femoral anteversion (FAV) is difficult to evaluate using conventional radiographs, while repeated computed tomography (CT) raises concerns regarding radiation exposure. A mobile application for 3-dimensional (3D) femoral reconstruction from conventional radiographs has recently been developed. This study evaluated the agreement and reliability of FAV measurements using the mobile application and investigated longitudinal changes in FAV after surgical treatment. Longitudinal changes in FAV were evaluated in 33 pediatric patients who underwent flexible intramedullary nailing, with the contralateral femur used as a within-patient comparator when corresponding measurements were available. A separate validation cohort of 15 patients (30 femora) was used to compare FAV measurements obtained using the mobile application with those obtained using 3D-CT. The mobile application demonstrated excellent inter-observer (ICC, 0.965; 95% confidence interval [CI], 0.939–0.981) and intra-observer reliability (ICC, 0.935; 95% CI, 0.888–0.965), with a strong correlation with 3D-CT (r = 0.944, P < .001). Bland–Altman analysis showed a mean bias of 2.11° (95% limits of agreement, −7.77° to 11.98°). The mean paired difference between the fracture and contralateral sides was −2.97° initially (P = .190) and −4.76° at final follow-up (P = .060). On the fracture side, FAV showed a significant overall effect of time (P = .032), decreasing from 27.43° ± 15.62° postoperatively to 23.92° ± 15.35° at final follow-up (mean difference, −3.52°; 95% CI, −5.83° to −1.21°; adjusted P = .009). The mobile application demonstrated high reliability, with a mean bias of 2.11° relative to 3D-CT, although individual-level agreement showed variability. FAV on the fracture side decreased significantly over time after fixation, whereas the side-to-side differences were not statistically significant at the initial or final assessments. However, the magnitude of the FAV reduction was relatively small (approximately 3.5°), and further studies are needed to determine its clinical significance. The mobile application may provide a useful method for estimating FAV from conventional radiographs during follow-up of pediatric femoral shaft fractures.
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BibTeX
@article{lee2026mobile,
title = {{Mobile application-based assessment of rotational changes after surgical treatment for pediatric femoral shaft fracture : A retrospective observational study}},
author = {Seung Cheol Lee and Ha Song Lee and Seo Young Jeon and Young Jae Moon and Darryl D’Lima and Seong Il Wang},
journal = {Medicine},
year = {2026},
month = oct,
doi = {10.1097/md.0000000000051385},
url = {https://europepmc.org/article/PMC/PMC13727264},
note = {CC BY-NC},
}
RIS
TY - JOUR
TI - Mobile application-based assessment of rotational changes after surgical treatment for pediatric femoral shaft fracture : A retrospective observational study
AU - Seung Cheol Lee
AU - Ha Song Lee
AU - Seo Young Jeon
AU - Young Jae Moon
AU - Darryl D’Lima
AU - Seong Il Wang
PY - 2026
DA - 2026/10/30
JO - Medicine
DO - 10.1097/md.0000000000051385
UR - https://europepmc.org/article/PMC/PMC13727264
AB - Although rotational changes after fixation of pediatric femoral shaft fractures are an important concern, femoral anteversion (FAV) is difficult to evaluate using conventional radiographs, while repeated computed tomography (CT) raises concerns regarding radiation exposure. A mobile application for 3-dimensional (3D) femoral reconstruction from conventional radiographs has recently been developed. This study evaluated the agreement and reliability of FAV measurements using the mobile application and investigated longitudinal changes in FAV after surgical treatment. Longitudinal changes in FAV were evaluated in 33 pediatric patients who underwent flexible intramedullary nailing, with the contralateral femur used as a within-patient comparator when corresponding measurements were available. A separate validation cohort of 15 patients (30 femora) was used to compare FAV measurements obtained using the mobile application with those obtained using 3D-CT. The mobile application demonstrated excellent inter-observer (ICC, 0.965; 95% confidence interval [CI], 0.939–0.981) and intra-observer reliability (ICC, 0.935; 95% CI, 0.888–0.965), with a strong correlation with 3D-CT (r = 0.944, P < .001). Bland–Altman analysis showed a mean bias of 2.11° (95% limits of agreement, −7.77° to 11.98°). The mean paired difference between the fracture and contralateral sides was −2.97° initially (P = .190) and −4.76° at final follow-up (P = .060). On the fracture side, FAV showed a significant overall effect of time (P = .032), decreasing from 27.43° ± 15.62° postoperatively to 23.92° ± 15.35° at final follow-up (mean difference, −3.52°; 95% CI, −5.83° to −1.21°; adjusted P = .009). The mobile application demonstrated high reliability, with a mean bias of 2.11° relative to 3D-CT, although individual-level agreement showed variability. FAV on the fracture side decreased significantly over time after fixation, whereas the side-to-side differences were not statistically significant at the initial or final assessments. However, the magnitude of the FAV reduction was relatively small (approximately 3.5°), and further studies are needed to determine its clinical significance. The mobile application may provide a useful method for estimating FAV from conventional radiographs during follow-up of pediatric femoral shaft fractures.
SN - 0304-5412
SN - 1536-5964
SN - 0025-7974
ER -