Treffer: Comparison of supine and beach-chair positions in antegrade intramedullary nailing of humeral shaft fractures: a retrospective study on surgery duration and fluoroscopy exposure.

Purpose: This study aims to compare the duration of surgery and fluoroscopy exposure between the supine and beach-chair positions during antegrade intramedullary nailing (IMN) of humeral shaft fractures.
Methods: A retrospective, single-center study was conducted at a German Level I Trauma Center from January 2021 to August 2024. Patients included were aged 18-95 with confirmed humeral shaft fractures diagnosed via radiographic imaging. Exclusion criteria comprised fractures older than two weeks, polytrauma cases, concomitant neurovascular injuries, and patients undergoing alternative osteosynthesis procedures during the same surgery. Surgery was performed in either the supine or beach-chair position, and comparisons were made regarding operative duration, fluoroscopy time, and radiation dose exposure. Furthermore, the influence of fracture complexity (A-,B- and C- fractures according to AO) on these three parameters was tested. Demographic data were also collected and analyzed.
Results: A total of 79 patients were initially considered, with 59 meeting the inclusion criteria after the exclusion of 20 polytrauma cases. The final cohort consisted of 25 males (42.4%) and 34 females (57.6%), with a mean age of 67.1 years (± 20.1) and a mean BMI of 25.6 (± 5.6). Surgical outcomes demonstrated that procedures performed in the beach-chair position were significantly longer (103.5 ± 54.0 min) compared to those in the supine position (89.0 ± 42.0 min, p = 0.023). Furthermore, radiation exposure was considerably lower in the supine position (1,0 centigray/cm ²  ± 65,6) compared to the beach-chair position (161.4 centigray/cm ²  ± 245.1, p < 0.001). Although fluoroscopy duration was slightly longer in the beach-chair position (4.0 ± 4.2 min) than in the supine position (3.0 ± 2.6 min), this difference was not statistically significant. Neither surgery time (p = 0.855), nor fluoroscopy duration (p = 0.726), nor fluoroscopy dose (p = 0.052) reached a statistically significant difference in surgeries for A, B and C fractures.
Conclusion: Supine positioning for antegrade IMN of humeral shaft fractures significantly reduces both operative duration and radiation exposure compared to the beach-chair position, whereas fracture complexity does not significantly influence these parameters. The findings suggest that the supine position offers a viable alternative for patient positioning in these procedures.
(© 2025. The Author(s).)

Declarations. Conflict of interest: The authors declare that they do not have any conflict of interest. Ethical approval: The present study was approved by the ethics committee of the Medical Faculty, University of Munich (Project No. 23–0971). The study was conducted in accordance with the Declaration of Helsinki of 1964 and its later amendments.