Comparison of dynamic hip screw surgical technique between lateral and supine positions for intertrochanteric and basicervical femur fractures

Objectives: Intertrochanteric femur fractures are common injuries in the elderly. The dynamic hip screw (DHS) is a standard and effective method for the fixation of stable intertrochanteric fractures. This study aimed to assess the applicability of DHS in the lateral position and to compare early results with those in the supine position. Methods: Forty-one patients who underwent surgery for arbeitsgemeinschaft für osteosynthesefragen-Orthopedic trauma association (AO-OTA) 31A1.1–31B3 femoral fractures between November 2022 and August 2025 were retrospectively evaluated. Patients were operated in the lateral ( n = 21) or supine ( n = 20) positions. Surgical preparation time, operative time, surgeon scores for ease of reduction and surgery, number of fluoroscopy shots, quality of postoperative reduction, and 3-month union and complication data were analyzed. Results: The median age of the patients was 70 (63.5–81), 53.7% ( n = 22) were female, and 46.3% ( n = 19) were male. Operative time was similar, but operating room preparation time was significantly shorter in the lateral position group ( P < 0.001). No difference was found between surgeons’’ scores for ease of reduction and surgery, but the surgical field of view was rated better in the lateral position group ( P = 0.036). The number of fluoroscopy shots was similar. Reduction quality and 3-month union rates were comparable between the two groups. Conclusion: DHS application in the lateral position is safe, feasible, and yields results comparable to those in the supine position. Shorter preparation time and improved surgical field control are significant advantages. It can be considered an alternative, particularly in centers without a traction table or with limited personnel and technical resources.