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

Abstract

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