Abstract
Background
Femoral intramedullary nailing is traditionally performed with the patient supine on a fracture table. We aimed to describe a case series of femoral intramedullary nailing for fracture in the lateral position, with discussion of the operative technique.
Methods
A retrospective analysis identified 52 patients who underwent femoral intramedullary nailing performed in a lateral position without traction over a 5-year period at a single level 1 trauma center. Medical records were reviewed for demographics, blood loss including need for transfusion, operative duration, complications, length of stay, fracture union, re-operation and death.
Results
There were 24 subtrochanteric, 16 peri-trochanteric and 12 diaphyseal femoral fractures. Mean operative time was 136.2 ± 101.4 min with a mean estimated blood loss of 372.5 ± 349.6 ml. Seventeen patients required blood transfusion. Mean length of stay was 10.3 ± 8.1 days. There were 3 (5.8%) surgical (compartment syndrome, infection and retained drain) and 12 (23.1%) medical complications, with a 30-day mortality rate of 3.8% (2). Mean follow-up was 9.9 ± 8.7 months. The union rate was 94.2% (49) and 3.8% (2) patients required revision fixation (hardware exchange for irritation and exchange nailing for non-union). Discharge destination was home, rehabilitation center and specialized nursing facility in 21 (40.4%), 16 (30.8%) and 15 (28.8%) patients, respectively.
Discussion and conclusion
Femoral intramedullary nailing in the lateral decubitus position is a useful technique of managing peri-trochanteric, subtrochanteric and diaphyseal femoral fractures. We describe a known technique with technical tips, which has distinct advantages over traditional supine positioning especially in certain patient and fracture types. In addition, operative times, blood loss, length of stay, revision and outcomes were comparable to the literature.
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References
Turgut A, Kalenderer Ö, Günaydın B et al (2010) Fixation of intertrochanteric femur fractures using Proximal Femoral Nail Antirotation (PFNA) in the lateral decubitus position without a traction table. Acta Orthop Traumatol Turc 48(5):513–520
Bishop JA, Rodriguez EK (2010) Closed intramedullary nailing of the femur in the lateral decubitus position. J Trauma 68(1):231–235
Wolinsky P, Tejwani N, Richmond JH et al (2002) Controversies in intramedullary nailing of femoral shaft fractures. Instr Course Lect 51:291–303
Carr JB, Williams D, Richards M (2009) Lateral decubitus positioning for intramedullary nailing of the femur without the use of a fracture table. Orthopedics 32(10):721–724
Friederichs J, von Rüden C, Hierholzer C, Bühren V (2015) Antegrade femoral intramedullary nailing in a lateral position. Unfallchirurg 118(4):295–301
Sloan M, von Keudell A, Walley KC et al (2016) Closed cephalomedullary nailing with patient in lateral decubitus position for repair of peritrochanteric femoral fracture. JBJS Essent Surg Technol 6(1):6
Tucker MC, Schwappach JR, Leighton RK et al (2007) Results of femoral intramedullary nailing in patients who are obese versus those who are not obese: a prospective multicenter comparison study. J Orthop Trauma 21(8):523–529
McKee MD, Waddell JP (1994) Intramedullary nailing of femoral fractures in morbidly obese patients. J Trauma 36(2):208–210
Hales CM, Carroll MD, Fryar CD, Ogden CL (2017) Prevalence of obesity among adults and youth: United States, 2015–2016. NCHS Data Brief 288:1–8
Sonmez MM, Camur S, Erturer E et al (2017) Strategies for proximal femoral nailing of unstable intertrochanteric fractures: lateral decubitus position or traction table. J Am Acad Orthop Surg 25(3):e37–e44
Ozsoy MH, Basarir K, Bayramoglu A et al (2007) Risk of superior gluteal nerve and gluteus medius muscle injury during femoral nail insertion. J Bone Joint Surg Am 89(4):829–834
Jaarsma RL, van Kampen A (2004) Rotational malalignment after fractures of the femur. J Bone Joint Surg Br 86(8):1100–1104
Brumback RJ, Ellison TS, Molligan H et al (1992) Pudendal nerve palsy complicating intramedullary nailing of the femur. J Bone Joint Surg Am 74(10):1450–1455
France MP, Aurori BF (1992) Pudendal nerve palsy following fracture table traction. Clin Orthop Relat Res 276:272–276
Anglen J, Banovetz J (1994) Compartment syndrome in the well leg resulting from fracture-table positioning. Clin Orthop Relat Res 301:239–242
Reahl BS, O’Hara NN, Coale M et al (2018) Is lateral femoral nailing Associated with Increased in intensive care unit days? A propensity-matched analysis of 848 cases. J Orthop Trauma 32(1):39–42
Stephen DJ, Kreder HJ, Schemitsch EH et al (2002) Femoral intramedullary nailing: comparison of fracture-table and manual traction. A prospective, randomized study. J Bone Joint Surg Am 84(9):1514–21
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Johnsen, P., Satpathy, J., Patel, N.K. et al. Antegrade femoral nailing in the lateral decubitus position: a case series, technical tips and review of literature. Eur J Orthop Surg Traumatol 33, 381–384 (2023). https://doi.org/10.1007/s00590-021-03200-z
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DOI: https://doi.org/10.1007/s00590-021-03200-z