Lateral decubitus versus supine position in treatment of intertrochanteric fractures with proximal femoral nail antirotation

Abstract

Objective To compare the lateral decubitus and supine position in the treatment of femoral intertrochanteric fractures with femoral proximal nail antirotation (PFNA). Methods A retrospective analysis was performed of the 85 patients with intertrochanteric fracture who had been treated at our hospital between September 2013 and September 2014. They were 24 men and 61 women, 28 to 99 years of age (average, 78.5 years). By Evans-Jensen classification, one case was type Ⅰ, 15 cases were type Ⅱ, 40 type Ⅲ, 23 type IV, and 6 type V. All the patients were treated with internal fixation with PFNA. Lateral decubitus position was adopted in 45 cases and supine position in 40. The 2 groups were compared in terms of operation time, intraoperative bleeding volume, difference between preoperative and postoperative hemoglobin values, tip-apex distance (TAD), calcar tip-apex distance (Cal-TAD), fracture healing time, and Harris score of the hip joint. Results The 85 patients were followed up for 9 to 21 months (average, 13.6 months). Both 2 groups obtained fracture healing, with no screw cut-out. The lateral decubitus group had significantly less operation time (60.3±17.5 min) and intraoperative bleeding volume (70.8±37.8 mL) than the supine position group (72.7±19.7 min and 90.3±20.9 mL, respectively) (P 0.05). Conclusion In the treatment of femoral intertrochanteric fractures with PFNA, lateral decubitus position may be associated with shorter operation time and less intraoperative blood loss compared with supine position. Key words: Hip fractures; Fracture fixation, intramedullary; Bone nails; Position