Fracture Table vs. Lateral Positioning for Intramedullary Fixation of Femur Fractures (The FLiP Study): A protocol for a pilot randomized controlled trial

Background: Femoral Shaft fractures are devastating and life threatening injuries. Femoral shaft fractures are most commonly treated with intramedullary fixation. Malrotation of the injured limb after fixation is a common and significant complication following femoral shaft fractures. During the operation, patients can be positioned either supine or in a lateral position. Additionally, patients can be placed on a standard radiolucent operating room table, or placed on a fracture table with traction statically applied to the operative limb throughout the case. Previous case series and cohort studies have shown equivalence between study groups, but choice between positioning options remains controversial. Methods: This represents a protocol for a randomized controlled pilot trial. We will be compared lateral positioning with use of manual traction to supine positioning with use of a fracture table. Primary outcomes will be in assessment for feasibility for a future full scale randomized trial, including evaluating patient recruitment, patient compliance with followup, contamination between treatment arms and others. Results: The primary outcome will be feasibility for a future trial. Secondary outcomes will include malrotation as measured through postoperative computed tomography scans and gait analysis at 6 months.

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Fracture Table vs. Lateral Positioning for Intramedullary Fixation of Femur Fractures (The FLiP Study): A protocol for a pilot randomized controlled trial

10.7287/peerj.preprints.27875v1 ◽

2019 ◽

Author(s):

Daniel Axelrod ◽

Herman Johal ◽

Kim Madden ◽

Francesc Marcano ◽

Carlos Prada

Keyword(s):

Pilot Trial ◽

Case Series ◽

Femoral Shaft ◽

Intramedullary Fixation ◽

Femoral Shaft Fractures ◽

Randomized Controlled ◽

Femur Fractures ◽

Shaft Fractures ◽

Fracture Table ◽

Lateral Positioning

Background: Femoral Shaft fractures are devastating and life threatening injuries. Femoral shaft fractures are most commonly treated with intramedullary fixation. Malrotation of the injured limb after fixation is a common and significant complication following femoral shaft fractures. During the operation, patients can be positioned either supine or in a lateral position. Additionally, patients can be placed on a standard radiolucent operating room table, or placed on a fracture table with traction statically applied to the operative limb throughout the case. Previous case series and cohort studies have shown equivalence between study groups, but choice between positioning options remains controversial. Methods: This represents a protocol for a randomized controlled pilot trial. We will be compared lateral positioning with use of manual traction to supine positioning with use of a fracture table. Primary outcomes will be in assessment for feasibility for a future full scale randomized trial, including evaluating patient recruitment, patient compliance with followup, contamination between treatment arms and others. Results: The primary outcome will be feasibility for a future trial. Secondary outcomes will include malrotation as measured through intraoperative radiographs, postoperative computed tomography scans and gait analysis at 6 months.

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Treatment of femoral shaft fractures in polytrauma patients using Mitkovic type internal fixator

Acta chirurgica iugoslavica ◽

10.2298/aci0702033s ◽

2007 ◽

Vol 54 (2) ◽

pp. 33-38 ◽

Cited By ~ 1

Author(s):

P.M. Stojiljkovic ◽

Z.S. Golubovic ◽

M.B. Mitkovic ◽

D.S. Mladenovic ◽

I.D. Micic ◽

...

Keyword(s):

Femoral Shaft ◽

Internal Fixator ◽

Mortality And Morbidity ◽

Femoral Shaft Fractures ◽

Femur Fractures ◽

Shaft Fractures ◽

Polytrauma Patients ◽

Kuntscher Nail ◽

Polytrauma Patient ◽

Bone Vascularization

Polytrauma remains a major social, economic and medicine affliction. Successful surgical treatment of polytrauma patient?s requires an approach predicated on prioritizing injuries. An isolated fractures rarely poses any threat but in association with multiple injuries, a fractures assumes greater significance. Proper management of femur fractures in polytrauma can greatly reduce the mortality and morbidity. In this work the results of the operative treatments of the femoral shaft fractures in polytrauma patients using Mitkovic type internal fixator (14 patients) and Kuntscher nail (9 patients) are compared. The average patients age was 28.43 years (range 16 to 61). Internal fixation using Mitkovic type internal fixator can be method of choose in treatment of femur fractures in polytrauma patient?s. Its application is relatively simple. It doesn?t damage the periosteal and meduullary bone vascularization, which favors osteosynthesis and provides considerable contribution in osteogensis. .

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Evaluation of Intramedullary Fixation for Pediatric Femoral Shaft Fractures in Developing Countries

Journal of Orthopaedic Trauma ◽

10.1097/bot.0000000000001131 ◽

2018 ◽

Vol 32 (6) ◽

pp. e210-e214 ◽

Cited By ~ 1

Author(s):

Andrew T. Chen ◽

William Z. Morris ◽

Lewis G. Zirkle ◽

Raymond W. Liu

Keyword(s):

Developing Countries ◽

Femoral Shaft ◽

Intramedullary Fixation ◽

Femoral Shaft Fractures ◽

Shaft Fractures

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Intramedullary Nailing of Femoral Shaft Fractures : Comparison between with and without the Fracture Table

Journal of the Korean Fracture Society ◽

10.12671/jksf.2000.13.2.320 ◽

2000 ◽

Vol 13 (2) ◽

pp. 320 ◽

Cited By ~ 1

Author(s):

Jung Jae Kim ◽

Yong Gab Jeong ◽

Kwang Hwan Jung ◽

Soo Sung Park ◽

Eu Gene Kim

Keyword(s):

Intramedullary Nailing ◽

Femoral Shaft ◽

Femoral Shaft Fractures ◽

Shaft Fractures ◽

Fracture Table

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Closed Antegrade Interlocked Nailing of Femoral Shaft Fractures Operated up to 2 Weeks Postinjury in the Absence of a Fracture Table or C-arm

Journal of Trauma and Acute Care Surgery ◽

10.1097/01.ta.0000210269.05305.75 ◽

2006 ◽

Vol 61 (2) ◽

pp. 457-460 ◽

Cited By ~ 13

Author(s):

Sujata Aiyer ◽

Jairam Jagiasi ◽

Harshad Argekar ◽

Sudhir Sharan ◽

Bibhas Dasgupta

Keyword(s):

Femoral Shaft ◽

Femoral Shaft Fractures ◽

Shaft Fractures ◽

Fracture Table

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Lateral vs. Supine Positioning for Femoral Intramedullary Nailing: A Systematic Review of Comparative Studies

McMaster University Medical Journal ◽

10.15173/mumj.v17i1.2283 ◽

2020 ◽

Vol 17 (1) ◽

Author(s):

Mohamed Sarraj ◽

Daniel E Axelrod ◽

Sarah Zhu ◽

Herman Johal

Keyword(s):

Systematic Review ◽

Intramedullary Nailing ◽

Full Text ◽

Comparative Studies ◽

Femoral Shaft ◽

Definitive Treatment ◽

Femoral Shaft Fractures ◽

Shaft Fractures ◽

Lateral Positioning ◽

Full Text Screening

Femoral shaft fractures are devastating injuries that usually result from high-energy mechanisms in victims of poly-trauma. Reamed and statically locked intramedullary nailing (IMN) is the definitive treatment modality for femoral shaft fractures. Patients are most commonly positioned either supine or lateral decubitus. There remains considerable concern regarding the safety of lateral positioning in the traumatized patient, particularly in the management of a potentially difficult airway or concomitant C-spine injuries. We therefore undertook a systematic review of intraoperative positioning among patients with femoral shaft fractures following PRISMA guidelines. Title and abstract screening, full text screening, and data abstraction were all completed in duplicate. Methodological Index for Nonrandomized Studies (MINORS) scores were used to evaluate methodological quality. Results: 3018 studies were included in initial screening, with three studies ultimately meeting all inclusion criteria. A total of 1,949 patients were analyzed, with 684 patients treated in lateral positioning and 1,215 patients in supine positioning. Level of agreement was strong across title (κ = 0.872; 95% CI 0.794 to 0.951), abstract (κ = 0.801; 95% CI 0.585 to 1.000), and full-text screening (κ = 1.000). The consensus mean MINORS score of included studies was 17.67 ± 0.58, indicating good to high quality of evidence. Neither patient positioning offered obvious benefits such as fewer complications or shorter operative time. Furthermore, length of admission, days in ICU or on ventilator, and overall morbidity were not found to be significantly different between positions. Lateral positioning for intramedullary nailing of mid-shaft femur fractures appears to be a safe alternative to the standard supine positioning. There is a lack of both prospective and retrospective comparative studies investigating functional clinical outcomes in the literature.

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