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Case Reports in Orthopedics
Volume 2014, Article ID 301723, 4 pages
Case Report

The Cortical Step Sign Fails to Prevent Malrotation of a Nailed Femoral Shaft Fracture: A Case Report

1Division of Orthopaedic Surgery, Boundary Trails Health Centre, P.O. Box 2000, Station Main, Winkler, MB, Canada R6W 1H8
2Division of Orthopaedic Surgery, Health Sciences Centre, University of Manitoba, AD420–820 Sherbrook Street, Winnipeg, MB, Canada R3A 1R9

Received 11 November 2013; Accepted 27 November 2013; Published 29 January 2014

Academic Editors: R. A. Gosselin and W. Kolb

Copyright © 2014 Taranjit Tung and Ted Tufescu. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.


Intramedullary nailing has become the treatment of choice for diaphyseal femur fractures. Malrotation is a well-recognized complication of femoral nailing. Various techniques including the cortical step sign (CSS) have been described to minimize iatrogenic rotational deformity during femoral nailing. We present a case in which the use of the CSS resulted in a clinically significant malrotation requiring revision.