Comparison of supine position with the lateral decubitus position during surgery for femoral diaphyseal fractures

Femoral malrotation is one of the most common complications following closed intramedullary nailing, (IMN). We hypothesized that the patients’ position during surgery can affect the incidence and severity of this complication. The aim of the study was to compare the incidence and severity of femoral malrotation in patients with femoral diaphyseal fractures treated with IMN in supine or lateral decubitus positions.

In a randomized clinical trial, 42 patients with femoral diaphyseal fracture were assigned to two equal groups: supine (S) and decubitus positions (LD) during surgery. Femoral anteversion was determined in the fractured and healthy sides at the first postoperative day and the difference between the two considered as the degree of malrotation. Finally, mean degree of malrotation and the rate of required revision surgery were compared between groups.

The mean degree of malrotation in LD group (12.5±7.8°) was significantly higher than the S group (7.8±4.4°) (p=0.021).Number of patients who required revision surgery (difference >15°) was the 30% in LD group versus 5% in the S group.

Closed reduction of the femoral diaphyseal fractures using IMN in supine position is associated with decreased malrotation and revision surgery. Therefore, we recommend that for the treatment of closed femoral shaft fractures, IMN must be performed in supine position.