Lateral decubitus for treating pertrochanteric fractures using cephalomedullary nails

Abstract

ObjectiveTo perform a retrospective radiographic evaluation on the fracture reduction and implant position in the femoral head among patients with pertrochanteric fractures who had been treated using a cephalomedullary nail in lateral decubitus; and to assess factors that might interfere with the quality of the fracture reduction and with the implant position in using this technique.MethodsNineteen patients with a diagnosis of pertrochanteric fractures of the femur who had been treated using cephalomedullary nails in lateral decubitus were evaluated. For outpatient radiographic evaluations, we used the anteroposterior view of the pelvis and lateral view of the side affected. We measured the cervicodiaphyseal angle, tip-apex distance (TAD), spatial position of the cephalic element in relation to the head, and the bispinal diameter. To make an anthropometric assessment, we used the body mass index. Two groups of patients were created: one in which all the criteria were normal (TAD ≤25 mm, cervicodiaphyseal angle between 130° and 135° and cephalic implant position in the femoral head in the central–central quadrant); and another group presenting alterations in some of the criteria for best prognosis.ResultsFemale patients predominated (57.9%) and the mean age was 60 years. Seven patients presented a central–central cephalic implant position. One patient present a cervicodiaphyseal angle >135° and the maximum TAD was 32 mm; consequently, 12 patients presented some altered criteria (63.2%). None of the characteristics evaluated differed between the patients with all their criteria normal and those with some altered criteria, or showed any statistically significant association among them (p > 0.05).ConclusionThe technique described here enabled good reduction and good positioning of the implant, independent of the anthropometric indices and type of fracture.

Rotational alignment after intramedullary nailing in trochanteric fractures: Lateral decubitus versus supine position with fracture table. Does operative position matter?

“…Surgeon's comfort and ease of fracture reduction are undoubtedly important intraoperative factors affecting prognosis in the surgical treatment of hip fractures. In intramedullary nailing of trochanteric fractures, the lateral decubitus position takes a shorter time compared to the fracture table position, provides good fracture reduction and ease of implant placement (4,5). The aim of our study is to evaluate the effect of lateral decubitus position and fracture table on rotational alignment in patients who underwent intramedullary nailing due to hip fracture.…”

Femoral malalignment after gamma nail insertion in the lateral decubitus position

“…Using the lateral decubitus position in treating intertrochanteric fractures showed a satisfactory clinical outcome and a lower radiological complication rate as compared to the supine position. de Oliveira et al [ 11 ], recommended insertion of cephalomedullary nails in peritrochanteric fractures in lateral decubitus position believing that lateral decubitus enables good fracture reduction and good implant positioning [ 11 , 12 ].…”