Lateral decubitus positioning without traction significantly reduced setup time (13.73 vs 43.73 min) and radiation exposure compared to supine traction-table positioning in geriatric patients.
RCT (n=80)
Simple randomization
No
Does lateral decubitus PFN without traction reduce setup time, radiation exposure, and operative time compared to supine traction-table PFN in geriatric patients with unstable intertrochanteric fractures?
Lateral decubitus positioning for proximal femoral nailing improves setup efficiency and reduces radiation exposure, but increases the need for open reduction and blood loss compared to supine positioning.
Absolute Event Rate: 13.73% vs 43.73%
p-value: p=<0.001
Background: Patient positioning for proximal femoral nailing (PFN) in unstable intertrochanteric fractures remains controversial and may influence operative efficiency, radiation exposure, and reduction quality. This study compared lateral decubitus PFN without traction versus the conventional supine traction-table technique in geriatric patients. Methods: This prospective randomized comparative study enrolled patients aged >60 years with AO/OTA A2 unstable intertrochanteric fractures who were randomized to supine traction-table PFN (Group A) or lateral decubitus PFN on a radiolucent table (Group B). Primary outcomes were setup time, fluoroscopy (radiation) exposure, and operative time. Secondary outcomes included blood loss, need for open reduction, neck–shaft angle (NSA), tip–apex distance (TAD), and modified Baumgartner reduction quality. Results: Setup time was markedly shorter with lateral positioning (13.73 ± 2.26 vs 43.73 ± 6.19 min; P < 0.001), and radiation exposure was lower (60.53 ± 15.98 vs 68.48 ± 14.65 s; P = 0.023). Blood loss was higher in the lateral group (328.75 ± 84.65 vs 288.75 ± 48.68 mL; P = 0.011), and open reduction was more frequent (57.5% vs 17.5%; P < 0.001). Operative time was comparable (78.53 ± 15.13 vs 74.48 ± 8.56 min; P = 0.145). NSA (135.88 ± 5.94 vs 136.12 ± 6.27°; P = 0.864), TAD (23.58 ± 2.14 vs 23.15 ± 1.73 mm; P = 0.331), and reduction quality (good: 90% in both; P = 1.000) did not differ. Conclusions: Lateral decubitus PFN without traction improved setup efficiency and reduced radiation exposure while maintaining comparable radiographic outcomes, at the expense of more frequent open reduction and modestly higher blood loss.
Ebied et al. (2026) conducted an RCT in Unstable intertrochanteric fractures (AO/OTA A2) (n=80). Lateral decubitus positioning without traction vs. Supine traction-table positioning was evaluated on Setup time (minutes) (p=<0.001). Lateral decubitus positioning without traction significantly reduced setup time (13.73 vs 43.73 min) and radiation exposure compared to supine traction-table positioning in geriatric patients.