The lateral decubitus approach for complex proximal femur fractures: anatomic reduction and locking plate...

Unstable intertrochanteric or subtrochanteric fractures with significant proximal or distal extension or comminution are often a challenge for achieving stable fixation. In recent years, locked proximal femoral plates have been developed that aid fixation of these complex fractures often permitting the biological advantages of minimal contact or minimally invasive application. Although previously described with success using a standard lateral approach in the supine position, we describe a lateral decubitus position for the locked plating of proximal femur fractures. We have found that lateral positioning neutralizes the gravitational forces acting on the bone and soft tissues, facilitating reduction and exposure while continuing to be compatible with intraoperative image intensification. We present lateral positioning as a technical trick for anatomic and stable reduction of complex proximal femur fractures with proximal femoral locking plates and present a series of 10 cases that were treated with this combination of approach and internal fixation.