Rotational alignment after intramedullary nailing in trochanteric fractures: Lateral decubitus versus supine position with fracture table. Does operative position matter?

Abstract

Background: Fixation of trochanteric fractures with intramedullary nail in non-physiological position can cause poor functional outcomes. The aim of this study, evaluate the effect of intra-operative patient position on rotational alignment in intramedullary nail fixation of trochanteric fractures. Methods: Femoral rotational alignment of 84 trochanteric fracture patients who underwent intramedullary nailing was measured by comuted tomography (CT) images. Patients were divided into two groups: Supine position on fracture table (Group-1, n:42) and lateral decubitus (LD) position (Group-2, n:42). Femoral malrotation angles were measured and divided into three subgroups as insignificant, significant and excessive. Number of intra-operative fluoroscopy imaging, preparation time, surgery time and anesthesia time in both groups compared. Results: Malrotation degrees of patients in Group-1 ranged from 17° external rotation (ER) to 57° internal rotation (IR), with a mean of 10° IR. Of the patients in Group-1, 27 were in insignificant, 5 were in significant, and 10 were in excessive subgroup. Malrotation degrees of patients in Group-2 ranged from 33° ER to 47° IR, with a mean of 11° IR. Of patients in Group-2, 21 were in insignificant, 12 were in significant, and 9 were in excessive subgroup. There was no statistically significant relationship between patient position and malrotation angle. Number of intra-operative fluoroscopy imaging, preparation time and anesthesia time were statistically lower in Group-2. There was no statistically significant difference between Group-1 and Group-2 in terms of surgery time. Conclusion: Intramedullary nailing in LD position is a reliable and practical surgical method in treatment of femoral trochanteric fractures, since there is no need for use of a fracture table, surgeon is exposed to less radiation, no risk of complications related to traction of fracture table, and shorter operation time.