FRACTURE TABLE VERSUS LATERAL POSITIONING FOR INTRAMEDULLARY FIXATION OF FEMUR FRACTURES (THE FLIP STUDY): THE CLINICAL OUTCOMES OF A MULTICENTRE CLUSTER RANDOMIZED CROSSOVER PILOT STUDY

Femoral shaft fractures (FSFs) are common and severe injuries. Femoral malrotation is the most common complication following intramedullary nailing of FSFs and is associated with gait disturbance, pain, and reduced health related quality of life. There is no definitive research comparing two commonly used positions to treat these fractures; lateral positioning on a radiolucent table (LRT) and supine position on a fracture table (SFT). A pilot multicentre, prospective cluster randomized crossover trial was performed in three orthopaedic trauma centres. Patients over 18 years of age with femoral shaft fractures amenable for antegrade intramedullary fixation were included. Randomization was done in clusters by centre, with crossovers occurring every 2 months. Patients, outcome assessors, and statisticians were blinded to treatment allocation. One hundred and one patients were enrolled into the trial, with 47 patients treated using LRT and 54 using SFT. Feasibility outcomes of the trial have been previously reported. The odds of having a femoral malrotation angle of ≥15° versus < 1 5° in patients were 2.56 times higher in the SFT group than for those treated in the LRT group (95% Confidence Interval 1.02 to 6.40; p = 0.04). In both groups, patients were more likely to have an external rotation deformity compared to their native anatomy, though external rotation was more common in the SFT group when compared to LRT (69.8% versus 59.6%; p = 0.17). No secondary outcomes were found to be clinically important. In this clinical outcome assessment of patients enrolled in a feasibility trial, patients treated in supine position on a fracture table were more likely to have clinically important femoral malrotation after treatment for their femoral shaft fracture.