Comparing the supine and lateral positions for proximal femoral nail use in the treatment of intertrochanteric femoral fractures

Background/Aim: The management of unstable intertrochanteric fractures (ITF), which are becoming more common, is still a significant issue for public healthcare systems. As a result, successful fracture therapy is becoming a more crucial aspect of orthopedic practice. To treat older patients who have an ITF, this study compared the therapeutic outcomes and side effects of proximal femoral nail anti-rotation (PFNA) conducted in lateral decubitus and supine postures. Methods: One-hundred twenty patients between the ages of 65 and 90 who underwent PFNA surgery as a result of an unstable femoral ITF brought on by low-energy trauma were included in the study, which was conducted as a retrospective cohort study. Two groups of patients were established: (1) Group L, consisting of patients who underwent surgery in the lateral decubitus position and (2) Group S, consisting of patients who underwent surgery in the supine position. Several patient characteristics were compared: (1) demographic information, (2) length of hospital stay, (3) length of surgery, (4) intra-operative blood loss, (5) incision length, (6) number of intra-operative fluoroscopies, (7) duration of activity outside of bed, (8) duration of clinical recovery of fracture, (9) surgical complications, (10) patient outcomes, and (11) Harris hip scores (HHS). Results: Group L (60 patients) consisted of patients who underwent surgery in the lateral decubitus position, while Group S (60 patients) underwent surgery in the supine position (60 patients). The average hospital stay for patients receiving PFNA was 8.2 days for those in the supine position compared to 8.0 days for those in the lateral decubitus position. The difference between the operative times was significant (P<0.001) with 48.6 and 59.7 min in Groups L and S, respectively. Intra-operative blood losses in Groups L and S were 129.2 and 151.5 mL, respectively. Compared to Group S, Group L's mean incision length was much lower at 6 cm (as compared to 8 cm in Group S). The difference between the mean intra-operative radiation exposure times for Groups L and S was considerable at 9.38 versus 12.5 min. The mean times for fracture union and the HHS were not statistically different between the two groups after 12 weeks of treatment. Conclusion: ITFs in elderly patients can be successfully treated with PFNA in either the lateral decubitus or supine position. Surgical duration, blood loss, intra-operative X-ray exposure, and incision lengths were all reduced with PFNA performed in the lateral decubitus position. As a result, treatment of ITFs in older individuals may involve PFNA fixation in the lateral decubitus position. Particularly for people with a muscular gluteal region or obese patients, the lateral decubitus position is advised.