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Surgical Technique: Supine Patient Position With the Contralateral Leg Elevated for Femoral Intramedullary Nailing

  • Clinical Research
  • Published:
Clinical Orthopaedics and Related Research®

Abstract

Background

Intramedullary nailing can be performed with a fracture table or manual traction. Manual traction can be applied with the patient in either the supine or lateral decubitus (LD) position. However, in either of these positions, the reduction can be difficult because the fractured extremity is not positioned parallel to the floor and the contralateral leg on the operating room table overlaps the fractured limb while the fractured extremity is in full adduction. Therefore fluoroscopy time may be increased. Accordingly, we developed a technique with the patient supine and the contralateral leg elevated (SCLE).

Description of Technique

We performed anterograde femoral intramedullary nailing with the patient in the supine position with the contralateral leg elevated to allow easy nail entry, reduction, and locking. In this position, the uninjured leg was placed on the leg holder in a semilithotomy position to allow full hip adduction.

Methods

We retrospectively reviewed 63 patients treated with intramedullary nailing: 30 with the SCLE position (mean age, 38 years; 30% female) and 33 with the LD position (mean age, 37 years; 36% female). From the medical records we extracted demographic information, fracture pattern, intramedullary nail diameter, duration of fluoroscopy and operation, and complications. At the last visit, extremity lengths, rotation, and alignment were determined. Minimum followup was 46 months (mean, 46 months; range, 20–72 months).

Results

The mean durations of surgery and fluoroscopy were shorter for the SCLE group than the LD group: 98 versus 108 minutes and 3.4 versus 3.8 minutes, respectively. The open reduction rate was less in the SCLE group when compared with the LD group: 10% versus 36%.

Conclusions

We believe the SCLE technique is a reasonable treatment choice for femoral intramedullary nailing as it facilitates obtaining orthogonal views of the femur while possibly shortening surgery and fluoroscopy times.

Level of Evidence

Level III, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.

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Acknowledgments

We thank Cetin Isik MD, Ramazan Akmese MD, and Murat Altay MD for making the measurements of limb length, alignment, and rotation.

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Authors and Affiliations

  1. Department of Orthopaedics and Traumatology, Kecioren Training and Research Hospital, Kecioren, Ankara, Turkey

    Ahmet Firat MD

  2. Department of Orthopaedics and Traumatology, Atatürk Training and Research Hospital, Ankara, Turkey

    Osman Tecimel MD, Ali Ocguder MD & Murat Bozkurt

  3. Department of Orthopaedics and Traumatology, Etlik Ihtisas Training and Research Hospital, Ankara, Turkey

    Alper Deveci MD

Authors
  1. Ahmet Firat MD
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  2. Osman Tecimel MD
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  3. Alper Deveci MD
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  4. Ali Ocguder MD
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  5. Murat Bozkurt
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Corresponding author

Correspondence to Ahmet Firat MD.

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Each author certifies that he or she has no commercial associations (eg, consultancies, stock ownership, equity interest, patent/licensing arrangements, etc) that might pose a conflict of interest in connection with the submitted article.

All ICMJE Conflict of Interest Forms for authors and Clinical Orthopaedics and Related Research editors and board members are on file with the publication and can be viewed on request.

Each author certifies that his or her institution approved the human protocol for this investigation, that all investigations were conducted in conformity with ethical principles of research, and that informed consent for participation in the study was obtained.

This work was performed at the Atatürk Training and Research Hospital, Ankara, Turkey.

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Firat, A., Tecimel, O., Deveci, A. et al. Surgical Technique: Supine Patient Position With the Contralateral Leg Elevated for Femoral Intramedullary Nailing. Clin Orthop Relat Res 471, 640–648 (2013). https://doi.org/10.1007/s11999-012-2722-8

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  • DOI: https://doi.org/10.1007/s11999-012-2722-8

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