Rubinger L, et al. - Given that definitive internal fixation using reamed, locked intramedullary nailing (IMN) has become the standard of care in adequately resuscitated patients with femoral shaft fractures, which is commonly performed in the supine position with utilization of a fracture table and that there is possibility of achievement of lower complication rates with the lateral position, without the use of traction, researchers sought to define the attitudes, knowledge base and preferences of orthopaedic surgeons about patient positioning during antegrade IMN of femoral shaft fractures. They administered a web-based survey concerning the topic to orthopedic surgeon members of the AO North America, Canadian Orthopaedic Association and the Ontario Orthopaedic Association. Most surgeons (56%) preferred managing mid-shaft femur fractures in the supine position utilizing a fracture table compared with supine/sloppy lateral (29%) or direct lateral (12%) with the leg free draped. The sloppy lateral or direct lateral positioning with manual traction was more frequently preffered by academic and higher-level trauma center surgeons compared with community surgeons. Expertise and lack of available assistants were the most commonly cited perceived barrier for utilizing the lateral position. Interest in being involved in a randomized control trial comparing lateral positioning vs supine with traction was shown by 45% of respondents.