Closed femoral nailing in lateral decubitus position without a fracture table: a preliminary report of fifteen patients.

Background: The use of a fracture table is standard for closed intramedullary nailing of femoral fractures. Instead of a fracture table, some clinicians have successfully performed this operation in the supine position via manual traction. Here, we present our experience performing this operation in the lateral decubitus position without a fracture table.

Methods: From December 2001 to November 2002, we consecutively performed closed intramedullary femoral nailing in 15 patients with low comminuted femoral shaft fractures in the lateral decubitus position without a fracture table. We used manual or joystick traction to approximate the fracture fragments and introduced a guide pin. A reaming procedure was done with serial reamers of increasing diameters to reduce the fracture fragments. Then, the nail was inserted along the guide pin.

Results: Six femora underwent Küntscher nailing and nine femora underwent interlocking nailing. Nine procedures were completed via joystick traction and six were completed via manual traction only. All fifteen procedures were completed without any changes in the other operative methods. The mean operation time was 55 minutes for Küntscher nailing and 118.3 minutes for interlocking nailing. The average union time was 5.8 months with 100% union.

Conclusions: For low comminuted femoral shaft fractures, using manual or joystick traction in the lateral decubitus position without a fracture table is an alternative in closed femoral intramedullary nailing.