(FLiP) fracture-table vs. lateral positioning for femoral intramedullary nailing: A survey of orthopaedic surgeon preferences.

BACKGROUND

Femoral shaft fractures are common and severe injuries that often occur alongside other complex, high-energy injuries. Definitive internal fixation using reamed, locked intramedullary nailing (IMN) has become the standard of care in adequately resuscitated patients, commonly performed in the supine position with utilization of a fracture table. The lateral position, without the use of traction, offers an alternative that may be associated with lower complication rates. Given the lack of high-quality evidence in the area, this study was designed to assess the attitudes, knowledge base and preferences of Orthopaedic surgeons regarding patient positioning during antegrade IMN of femoral shaft fractures.

METHODS

Orthopedic surgeon members of the AO North America, Canadian Orthopaedic Association and the Ontario Orthopaedic Association were invited to participate in a web-based survey addressing the management of femoral shaft fractures and the need for further research in this area.

RESULTS

Most surgeons (56%) favored treating mid-shaft femur fractures in the supine position using a fracture table compared to supine/sloppy lateral (29%) or direct lateral (12%) with the leg free draped. Canadian surgeons showed a significantly higher preference for supine positioning with a fracture table when compared to their American colleagues. Academic and higher-level trauma center surgeons were more likely to prefer the sloppy lateral or direct lateral positioning with manual traction compared to community surgeons. The most commonly cited perceived barrier for utilizing the lateral position was expertise and lack of available assistants. Forty-five percent of respondents expressed interest in being involved in a randomized control trial comparing lateral positioning vs. supine with traction.

CONCLUSION

Consensus surrounding the positioning and utilization of traction in femoral shaft fractures is lacking. Given the perceived possible benefits and reduced complications using the lateral position and free-leg draping, further research is warranted to determine the optimal positioning for these injuries during femoral IMN.

LEVEL OF EVIDENCE

IV STUDY TYPE: Cross-sectional Survey.

Informations de copyright

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Déclaration de conflit d'intérêts

Declaration of Competing Interest Luc Rubinger: This author, their immediate family, and any research foundation with which they are affiliated did not receive any financial payments or other benefits from any commercial entity related to the subject of this article. Daniel Axelrod: This author, their immediate family, and any research foundation with which they are affiliated did not receive any financial payments or other benefits from any commercial entity related to the subject of this article. Anthony Bozzo: This author, their immediate family, and any research foundation with which they are affiliated did not receive any financial payments or other benefits from any commercial entity related to the subject of this article. Aaron Gazendam: This author, their immediate family, and any research foundation with which they are affiliated did not receive any financial payments or other benefits from any commercial entity related to the subject of this article. Jamal Al-Asiri: This author, their immediate family, and any research foundation with which they are affiliated did not receive any financial payments or other benefits from any commercial entity related to the subject of this article. Herman Johal: This author, their immediate family, and any research foundation with which they are affiliated did not receive any financial payments or other benefits from any commercial entity related to the subject of this article.