BACKGROUND: Subtrochanteric femur fractures are challenging to treat due to complex anatomy and high mechanical stresses. Cephalomedullary nailing is the standard treatment, often performed with the patient supine on a traction table, but this can prolong setup and cause complications (pressure or nerve injuries). Lateral decubitus positioning without a traction table may facilitate reduction and reduce traction-related risks, yet comparative data in subtrochanteric fractures are limited. This study compared outcomes of lateral decubitus versus traction table positioning for subtrochanteric fracture nailing. METHODS: A retrospective cohort study included 68 patients with subtrochanteric femur fractures treated with cephalomedullary nails. Patients underwent surgery supine on a traction table (n = 37) or in lateral decubitus without a traction table (n = 31). Operative metrics (entry point determination time, operative time, fluoroscopy duration, and blood loss) and postoperative outcomes (transfusion requirements, time to mobilization, complications, and final Harris Hip Score) were compared between groups. RESULTS: Lateral decubitus positioning was associated with shorter entry-point determination time (median 2 vs. 7 min; p = 0.05), shorter operating-room time (80.3 ± 23.6 vs. 108.2 ± 23.2 min; p = 0.03), reduced fluoroscopy time (151.2 ± 19.2 vs. 178.2 ± 16.1 s; p = 0.03), and lower estimated blood loss (752 ± 346 vs. 1459 ± 611 mL; p = 0.01) compared with traction-table positioning. No statistically significant differences were observed in transfusion requirements, time to mobilization, final Harris Hip Score, or complication rates (all p > 0.05). CONCLUSION: Compared with traction-table positioning, lateral decubitus cephalomedullary nailing was associated with better functional outcome, shorter operative and fluoroscopy times, and lower estimated blood loss, while union and complication rates were similar between groups. These findings suggest that lateral decubitus positioning is a viable alternative for subtrochanteric fracture fixation, particularly when traction-table setup may compromise operating-room efficiency. Given the observational design and potential confounding related to reduction techniques and surgeon factors, these findings should be interpreted as associations; prospective studies are warranted.
Kahraman et al. (Mon,) studied this question.