A Novel C-arm Rotation and Limb-Positioning Algorithm to Obtain a Reliable Lateral Femoral Neck View in Lateral...

Area of Science:

• Orthopedic Surgery
• Trauma Surgery
• Surgical Techniques

Background:

• Proximal femoral fractures are common, particularly in elderly patients.
• Traditional surgical approaches often require traction tables, which can be challenging.
• The lateral decubitus position offers an alternative positioning for surgery.

Purpose of the Study:

• To evaluate the feasibility of proximal femoral nailing (PFN) in the lateral decubitus position.
• To assess early postoperative radiographic and technical outcomes of a standardized, limb-based approach.
• To analyze lag screw position and tip-apex distance (TAD) without a traction table.

Main Methods:

• Retrospective study of 52 adult patients undergoing PFN in lateral decubitus position.
• Utilized a standardized, limb-based surgical algorithm.
• Collected demographic data, fracture classifications (Evans, Boyd-Griffin), operative parameters, and early postoperative radiographic measurements (TAD, Cleveland-Bosworth).

Main Results:

• Mean operative duration was 43.6 minutes, longer for unstable fractures.
• 73.1% of lag screws achieved central-central placement (Cleveland-Bosworth system).
• Mean TAD was 17.7 mm, with 96.2% of patients < 25 mm; 3.8% experienced cut-out.

Conclusions:

• A novel, standardized limb-based PFN algorithm in the lateral decubitus position is feasible.
• The approach demonstrates reproducible early radiographic outcomes, including acceptable TAD and favorable screw positioning.
• This technique offers a viable alternative to traditional methods, potentially simplifying surgical workflow.