Evidence map›Paper›PMID 41821082›Full record

ArticlePilot and feasibility studies2026

Fracture table vs. lateral positioning for intramedullary fixation of femur fractures (The FLiP Trial): the feasibility of a cluster randomized crossover trial.

FLiP Investigators, Daniel E Axelrod, Sheila Sprague, Ernesto Guerra-Farfan, Yaiza Garcia-Sanchez, Brad Meulenkamp, Melanie Dodd-Moher, Sofia Bzovsky, Christy Shibu, Gina Del Fabbro and 3 more

Registry-linked trialAbstract read
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In one paragraph

Article in Pilot and feasibility studies, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT03868280 (Fracture Table vs. Lateral Positioning for Intramedullary Fixation of Femur Fractures), which is not on this map. Not yet cited in PubMed.

0numbers the graph read from it
0cells of the map it votes in
0citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

NCT03868280 naunknown statusnot on this map

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

TypeinterventionalSponsorHamilton Health Sciences CorporationRan2020 to 2023Enrolled100ConditionsFemur FractureArmsAntegrade femoral nailing Supine Position, Antegrade Femoral Nailing Lateral Position
3 · Its place in the literature

Who cites it

0 citing papers in PubMed.

No citing paper in PubMed yet.

4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

13 authors.

FLiP Investigators
Daniel E AxelrodDivision of Orthopaedic Surgery, Department of Surgery, McMaster University, 1280 Main Street West, Hamilton, ON, L8S 4L8, Canada. daniel.axelrod@medportal.ca.ORCID http://orcid.org/0000-0002-0460-1298
Sheila SpragueDivision of Orthopaedic Surgery, Department of Surgery, McMaster University, 1280 Main Street West, Hamilton, ON, L8S 4L8, Canada.
Ernesto Guerra-FarfanDepartment of Orthopaedic Surgery and Traumatology, Vall d'Hebron Institut de Recerca (VHIR), Vall d'Hebron Hospital Universitari, Passeig Vall d'Hebron 119-129, Barcelona, 08035, Spain.
Yaiza Garcia-SanchezDepartment of Orthopaedic Surgery and Traumatology, Vall d'Hebron Institut de Recerca (VHIR), Vall d'Hebron Hospital Universitari, Passeig Vall d'Hebron 119-129, Barcelona, 08035, Spain.
Brad MeulenkampDivision of Orthopaedic Surgery, University of Ottawa, 75 Laurier Ave E, Ottawa, ON, K1N 6N5, Canada.
Melanie Dodd-MoherOttawa Hospital Research Institute, 1053 Carling Avenue, Ottawa, ON, K1Y 4E9, Canada.
Sofia BzovskyDivision of Orthopaedic Surgery, Department of Surgery, McMaster University, 1280 Main Street West, Hamilton, ON, L8S 4L8, Canada.
Christy ShibuDivision of Orthopaedic Surgery, Department of Surgery, McMaster University, 1280 Main Street West, Hamilton, ON, L8S 4L8, Canada.
Gina Del FabbroDivision of Orthopaedic Surgery, Department of Surgery, McMaster University, 1280 Main Street West, Hamilton, ON, L8S 4L8, Canada.
Jodi L GallantDivision of Orthopaedic Surgery, Department of Surgery, McMaster University, 1280 Main Street West, Hamilton, ON, L8S 4L8, Canada.
Thomas MammenDepartment of Medical Imaging, McMaster University, 1280 Main Street West, Hamilton, ON, L8S 4L8, Canada.
Herman JohalDivision of Orthopaedic Surgery, Department of Surgery, McMaster University, 1280 Main Street West, Hamilton, ON, L8S 4L8, Canada.

Funding

CIHR 169995
6 · The paper itself

Abstract

backgroundFemoral shaft fractures are common severe injuries that carry an elevated risk of operative complications, including femoral malrotation, neurologic, and vascular injuries. There is no definitive research comparing two commonly used surgical tables and patient positions in aiding with both reduction and fixation of femoral shaft fractures. The objective of this pilot trial was to test the feasibility of a cluster randomized crossover trial that assesses the comparative effectiveness of supine positioning on a fracture table versus lateral positioning on a radiolucent table for antegrade intramedullary fixation of femoral shaft fractures.

methodsThree orthopaedic trauma centres participated in this pilot trial. Each clinical site was randomized to a starting position, crossed over to the other treatment after 2 months, and alternated treatments in this fashion for the length of the trial. During the enrolment phase, we assessed compliance, enrolment rates, participant follow-up, and accurate documentation of the primary clinical outcome. The feasibility success criteria were: (1) 90% enrolment of eligible participants during enrolment phases; (2) 90% compliance with the trial interventions as per the cluster randomization crossover scheme; (3) timely collection of primary outcome data (i.e., within 6 weeks of fracture) in 95% of participants, (4) 90% completion of participant follow-up data; and (5) definition of the primary outcome as a categorical variable with an appropriate threshold value. Feasibility outcomes were summarized using descriptive statistics reported as means (standard deviation) or medians (first quartile, third quartile) for continuous variables depending on their distribution and counts (percentage) for categorical variables.

resultsAll five of the criteria for feasibility were met. Of the 110 eligible patients identified at the three clinical sites, 101 (91.8%) were enroled over a 2.5-year period and 95/101 (94.1%) received the correct cluster-assigned treatment. The primary outcome (malrotation measured on the CT) was accurately documented within 6 weeks of fracture for 98% of participants (99/101) with 93 participants completing the final follow-up (92.0%). Lastly, the trial data informed an appropriate threshold, a malrotation cut off of 15°, for the primary outcome in the definitive trial.

conclusionsThese results confirm the feasibility of a definitive trial comparing patient positioning during intramedullary fixation of femoral shaft fractures using a cluster randomized crossover trial design. However, due to funding limitations, a slower than anticipated enrolment, and concerns with surgical equipoise, this trial did not proceed to the definitive phase.

trial registrationClincialTrials.gov NCT03868280.

Indexed as

Antegrade intramedullary fixationCluster randomized crossover trialFemoral shaft fractureLateral positionSupine position

Identifiers

PMID41821082
PMCPMC13097760

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Registered trials

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.