**2. Materials and Methods**

This study was approved by the ethics committee of the institute, and informed consent was collected from all participants prior to commencement of this study and after provision of relevant verbal and written information. Patients diagnosed with malunion/nonunion and rotational malalignment secondary to surgical intervention for femoral or tibial fractures were selected to undergo the proposed procedure. A thorough evaluation of the diagnosis was carried out to identify any additional requirements during the surgical procedure.

The indication is based on symptoms and clinical and radiological evaluation. No clear indications for surgical correction are reported in the literature. Patients were included if they met any of the following criteria:


Patients were excluded if the patient refused additional surgery or had asymptomatic malrotation.

In addition to standard radiographic evaluation, all patients underwent preoperative computerized tomography (CT) scans to allow accurate identification of anatomical deformities. Femoral torsion was determined by measuring the angle between the long axis of the femoral neck and a line drawn parallel to the dorsal aspect of the femoral condyles on an axial CT image [16] (Figure 1). Tibial torsion was defined as the angle between the posterior tibial axis of the proximal tibia and the bimalleolar axis of the distal tibia on an axial CT image [17]. The difference in the angle of rotational alignment of the affected and contralateral unaffected limbs was calculated.
