Closed reduction at the supine position versus at the side-lying position in intramedullary nailing for femoral shaft fractures

Abstract

Objective To compare the short-term outcomes of closed reduction at the supine versus side-lying position in the intramedullary nailing for femoral shaft fractures.Methods A retrospective review was conducted of 71 patients with femoral shaft fracture who had been treated with closed reduction at the supine or side-lying position before intramedullary femoral nailing from June 2007 to September 2010.They were divided into 2 groups according to their reduction position.In the supine group there were 26 men and 7 women,with an average of 39.2 ± 9.6 years,and 15 cases of type A,9 ones of type B and 9 ones of type C by the AO classification.In the side-lying group,there were 29 males and 9 females,with an average of 42.2 ± 10.1 years,and 14 cases of type A,10 ones of type B and 14 ones of type C.The 2 groups were compared in terms of operation time,intraoperative blood loss,intraoperative fluoroscopy time,cases who changed to open reduction,postoperative complications,hospital stay and fracture healing time.Results The 71 patients were followed for 12 to 36 months (average,20 months).Compared with the side-lying group,the supine group had significantly longer operation time (139.9 ±46.8 minutes versus 75.5 ± 18.1 minutes)and fluoroscopy time (191.4 ± 78.6 seconds versus 93.3 ± 27.1 seconds),and significantly more blood loss (176.5 ± 103.0 milliliters versus 132.5 ±42.7 milliliters) (P ＜ 0.05).There were no significant differences regarding hospital stay or fracture healing time between the 2 groups (P ＞ 0.05).Three cases changed into open reduction in the supine group and no case did in the side-lying group.No short-term complications happened after operation in the 2 groups.Conclusion In the intramedullary nailing of femoral shaft fractures,closed reduction at the side-lying position is a good alternative because it has advantages of less blood loss,shorter operation time and fluoroscopy time,fewer complications and unnecessary requirement of a traction table. Key words: Femoral fractures; Fracture fixation, intramedullar; Bone nails; Posture