Fracture Table vs. Lateral Positioning for Intramedullary Fixation of Femur Fractures (The FLiP Study): A Pilot Cluster Randomized Crossover Trial

Fractures of the femur occur commonly following high-energy trauma, such as car crashes and falls from height. Over 1 in 10 road accidents result in a femur fracture that requires urgent surgical treatment. Patients with femur fractures often have poor alignment of their limb and poor quality of life post- fracture. The goal of this research program is to determine if patients' surgical positioning during femur fixation can improve rotational alignment of the operative limb and post-injury quality of life. During surgery to repair a femur fracture, the patient may be placed on their side (lateral positioning), or on their back (supine positioning). Lateral positioning is always done on a standard operating room table, while supine positioning is usually used on a fracture table. The lateral positioning may allow surgeons to better judge rotation of the femur, improving how the bone fragments are aligned; however, the supine position may be an easier approach. A recent survey of orthopaedic surgeons found approximately equal use between these two positions and tables. With limited evidence available to guide this clinical decision, surgeons tend to use the approach with which they are most comfortable. Prior to initiating a large definitive trial, a pilot study is needed to confirm feasibility. Our pilot study will enroll approximately 100 patients with femur fractures from two hospitals in Canada. Half of the participants will receive surgery for their fracture in the lateral position and the other half in the supine position. Participants will have a CT after surgery to assess the alignment of their leg. Quality of life data will be collected at 6 weeks, 3 months and 6 months post-fracture. Compliance with the protocol will be assessed. This study will determine the feasibility of conducting a larger definitive trial to determine whether lateral positioning results in better rotational allignment of the operative limb and improved quality of life.