Proximal femoral nailing for unstable trochanteric fractures: lateral decubitus position or traction table? A case-control study of 96 patients

Purpose: This study aimed to compare the treatment of unstable intertrochanteric femoral fractures with short proximal femoral nailing in elderly patients in the lateral decubitus position versus the supine position on traction tables.

Methods: From June 2020 to January 2022, a prospective case-control study was performed on 96 patients who presented with unstable trochanteric fractures treated by internal fixation via short proximal femoral nail (PFN). Patients were divided into two groups: Group A, which included patients who underwent surgery in the lateral position; and Group B, which included those in the supine position. Both groups were subjected to follow-up for 12 months.

Results: The mean setup time, surgery time, and blood loss were significantly greater in Group B than in Group A, while the hospital stay and fluoroscopy duration were similar in both groups. Regarding reduction quality and fixation (TAD (tip-apex distance), CDA (collodiaphyseal angle), and Reduction CRQC (change reduction quality criterion)), there were no statistically significant differences between the two groups; moreover, there were no intraoperative or postoperative complications in either group or the Harris hip score (67.65 ± 17.06 in Group A vs. 67.15 ± 17.05 in Group B).

Conclusion: The lateral decubitus and supine positions on a traction table are suitable for proximal femoral nailing with comparable outcomes, and surgeons can use either position according to their preferences and resources.