Objective: While the proximal femoral nail (PFN) is deemed a successful therapeutic approach for intertrochanteric femoral fractures, medical professionals lack agreement as to the optimal surgical positioning. Our objective was to determine the radiological superiorities of three different surgical positions (supine, lateral decubitus, and traction table).
Patients and methods: In this clinical study, 157 prospectively followed-up patients who were operated with PFN for intertrochanteric femur fractures between 2019 and 2022 were analyzed retrospectively. The demographic data of the patients, fracture type, preparation and surgery duration, recorded number of fluoroscopy shots, femoral neck quadrant of the lag screw, tip-apex distance, collodiaphyseal angle, and reduction quality were evaluated.
Results: Of the 157 patients evaluated in the study, 35 patients (22.3%) were operated in the supine position without traction table, 52 patients (33.1%) in the lateral decubitus position, and 70 patients (44.6%) in the supine position with a traction table. Significant differences were found between groups in terms of preparation duration (p<0.001) and number of fluoroscopy shots (p<0.001). Post-hoc analyses revealed that the preparation duration and the number of fluoroscopy shots were significantly lower in the supine position with manual traction. In radiological examinations, significant differences were found between the groups in all radiological parameters evaluated. Post-hoc analyses showed that the use of the traction table is associated with the lag screw quadrant (p<0.001), the reduction quality (p<0.001), the tip-apex distance (p=0.011), and the collodiaphyseal angle (p<0.001).
Conclusions: Despite the disadvantages, such as prolonged preparation duration and increased fluoroscopy usage, the use of a traction table stands out in PFN due to superior radiological results, such as a more successful reduction quality, a more accurately positioned lag screw and ideal tip-apex distance, and collodiaphyseal angulation.