Patient Positioning for Proximal Femur Fracture Fixation: a Review of Best Practices

Abstract

Purpose of Review Proximal femur fractures are common traumatic injuries treated by orthopedic surgeons. Preparation and positioning for surgical intervention are critical in the proper management of proximal femur fractures. The purpose of this study was to review the current evidence on the various positioning options for patients and to highlight the principles and emerging techniques to help orthopedic surgeons treat this common injury. Recent Findings Strategic patient positioning is key to the reduction and fixation of proximal femur fractures without complications. The use of intramedullary devices for the fixation of proximal femur fractures has led to an increased use of the modern fracture table. The fracture table should be used when surgeons are facile with its use to avoid significant complications. Recent best available evidence has suggested increased risk of malrotation associated with the use of the fracture table. The use of the radiolucent table offers the most flexibility, but limits surgeons as multiple assistants are needed to maintain reduction during fixation. Summary Positioning for proximal femur fractures is an important technique for general and trauma orthopedic surgeons. Surgeons need to be aware of the various techniques for positioning of proximal femur fractures due to the diversity of injury patterns and patient characteristics. Each positioning technique has it benefits and potential complications that every orthopaedic surgeon should be familiar with while treating these injuries.

Principles of Minimally Invasive Reduction and Nail Fixation for Subtrochanteric Femur Fractures

“…Commonly described positions include supine on a radiolucent table, lateral on a radiolucent table, and fracture table. 19 Supine positioning on a radiolucent flat table is the authors' preferred method. Ease of set-up and ability to treat other injuries in the same surgical setting make this position advantageous.…”

“…Commonly described positions include supine on a radiolucent table, lateral on a radiolucent table, and fracture table. 19…”

Validation of direct CT measurement of malrotation in femoral neck fractures: A bone model study

“…FNFs are gaining more importance, being a typical fracture of the elderly patient, with an incidence of 100,000 per year in the German population and affecting about 30% of all women [ 5 ]. Regarding FNFs, osteosynthesis, total hip arthroplasty, and hemiarthroplasty have to be considered, depending on the fracture type, patient age, and compliance [ 4 , 6 ]. Valgus impacted and less-displaced fractures (Garden type I and II) can be treated by osteosynthesis, even in elderly patients [ 4 , 5 , 7 ].…”

“…Valgus impacted and less-displaced fractures (Garden type I and II) can be treated by osteosynthesis, even in elderly patients [ 4 , 5 , 7 ]. Patients with higher grades of displacement are treated by hemiarthroplasty or total hip arthroplasty in older patients and by osteosynthesis in young patients [ 4 , 6 , 7 ].…”

Operative Traction Technique for an Intertrochanteric Femur Fracture in a Patient with Transfemoral Amputation

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