title: Strategies for Proximal Femoral Nailing of Unstable Intertrochanteric Fractures: Lateral Decubitus Position or Traction Table.
abstract: BACKGROUND
  The aim of this prospective randomized study was to compare the traction table and lateral decubitus position techniques in the management of unstable intertrochanteric fractures.
  
  
  METHODS
  Eighty-two patients with unstable intertrochanteric fractures between 2011 and 2013 were included in this study. All patients were treated surgically with the Proximal Femoral Nail Antirotation implant (DePuy Synthes). Patients were randomized to undergo the procedure in the lateral decubitus position (42 patients) or with the use of a traction table (40 patients). Patients whose procedure was not performed entirely with a semi-invasive method or who required the use of additional fixation materials, such as cables, were excluded from the study. The groups were compared on the basis of the setup time, surgical time, fluoroscopic exposure time, tip-to-apex distance, collodiaphyseal angle, and modified Baumgaertner criteria for radiologic reduction.
  
  
  RESULTS
  The setup time, surgical time, and fluoroscopic exposure time were lower and the differences were statistically significant in the lateral decubitus group compared with the traction table group. The collodiaphyseal angles were significantly different between the groups in favor of the lateral decubitus method. The tip-to-apex distance and the classification of reduction according to the modified Baumgaertner criteria did not demonstrate a statistically significant difference between the groups.
  
  
  CONCLUSIONS
  The lateral decubitus position is used for most open procedures of the hip. We found that this position facilitates exposure for the surgical treatment of unstable intertrochanteric fractures and has advantages over the traction table in terms of set up time, surgical time and fluoroscopic exposure time.
authors.affiliation: From the Department of Orthopaedics, Sisli Etfal Training and Research Hospital, Istanbul, Turkey (Dr. Sonmez, Dr. Camur, and Dr. Ugurlar), the Department of Orthopaedics, Istanbul Bilim University, Istanbul (Dr. Erturer), the Department of Orthopaedics, Istanbul Medipol University, Istanbul (Dr. Kara), and the Department of Orthopaedics, Istanbul University, Istanbul (Dr. Ozturk).
authors.forename: Mesut Mehmet
authors.initials: MM
authors.lastname: Sonmez
authors.forename: Savas
authors.initials: S
authors.lastname: Camur
authors.forename: Erden
authors.initials: E
authors.lastname: Erturer
authors.forename: Meric
authors.initials: M
authors.lastname: Ugurlar
authors.forename: Adnan
authors.initials: A
authors.lastname: Kara
authors.forename: Irfan
authors.initials: I
authors.lastname: Ozturk
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001858:Bone Nails; D005260:Female; D005594:Fracture Fixation, Intramedullary / Q000379:methods*; D006620:Hip Fractures / Q000601:surgery; D006801:Humans; D008297:Male; D061646:Operative Time; D056888:Patient Positioning / Q000379:methods*; D014143:Traction / Q000379:methods