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11Intraoperative radiological assessment

Femoral shaft – Nailing – Malrotation

Cortical step sign and diameter difference sign

The presence of considerable rotational deformity may be diagnosed by the difference in thickness of the cortices above and below the fracture zone.

The diameter difference sign is of use at levels where the bone cross section is oval rather than round. In cases of malrotation, the proximal and distal main fragments will appear to be of different diameters.