ROMANOFF - Rotational Malalignment in Nailing of Femur Fractures - A Comparative Randomized Study between Supine and Lateral Position

Femur shaft fractures are among the most common orthopaedic injuries, and intramedullary nailing is the standard treatment of choice for these fractures. It aims to achieve alignment, length, and stabilization with minimal soft tissue dissection. The advantages of the nail include early weight-bearing and joint mobilization. There are many ways to perform fracture fixation, including variations in the entry point, implant choice, patient position, and operating table. Antegrade intramedullary nailing is the preferred choice for most femur shaft fractures, except for distal third shaft fractures, which are sometimes amenable to retrograde nailing.

Common positions used for antegrade nailing of femur fracture fixation are:

Supine position on a fracture table

Lateral decubitus position on a radiolucent table

The use of a fracture table with patient in supine position has become the preferred

treatment for most of these fractures. Literature shows that there can be rotational malalignment following antegrade intramedullary nailing of femur fractures. Malrotation mainly occurs because the traction table can easily overpower the patient’s resting muscle tension, as well as due to the surgeons manipulation when reducing the fracture during positioning. It has been hypothesized that the lateral position provides easier access to the entry point, facilitates fracture reduction, and allows for rapid implant positioning. Although rotational malalignment can occur in both positions, according to the literature, the lateral position provides better fracture reduction and control of fracture fragments. There are many ways to determine femoral rotation which includes clinical assessment, radiological measurement, Ultrasound and CT. Unlike when using radiography or ultrasound, the

position of the patient does not influence the accuracy of CT measurement of femoral rotation. Hence in this study we plan to use CT as a definitive tool to evaluate the impact of patient positioning on rotational alignment.