Vol. 10, Issue 3 (2024)

Aim: To study the surgical procedure for Intertrochanteric fractures, Subtrochanteric fractures, unstable Intertrochanteric fractures, or femur shaft fractures.

Materials and Methods: This study involved a prospective analysis of 50 patients who underwent surgical intervention for Intertrochanteric fractures, Subtrochanteric fractures, Unstable Intertrochanteric fractures, or femoral shaft fractures. Patients were included in the study based on the following criteria: age between 18 and 85 years, diagnosed with Intertrochanteric, Subtrochanteric, Unstable Intertrochanteric, or femoral shaft fractures, fit for surgical intervention as determined by preoperative assessments, and provided informed consent. For the management of femoral fractures, our preferred method involves using a simple fluoroscopic table rather than the traditional traction table. The traction tables, while effective, present issues such as high cost (ranging from $2,000 to $20,000) and complications related to entry points and draping interference. Recent advancements have improved these tables, but alternative methods remain necessary.

Results: All patients (100%) were positioned in the lateral decubitus position, with the non-operative leg flexed at a 90-degree angle to improve fluoroscopic visualization. Sandbags were universally used to prevent shaft sagging, with placements near the knee and ankle. An additional sandbag was used in 30% of the cases, indicating variability in the degree of support needed based on the specific fracture and patient anatomy. Gravity-assisted reduction was successful in 84% of the cases, reducing the need for manual traction, which was only required in 16% of cases. This highlights the effectiveness of the lateral decubitus position and the strategic use of sandbags in facilitating fracture reduction. The incidence of complications was relatively low, with infections occurring in 6% of the patients, non-union in 4%, malunion in 2%, and hardware failure in 2%. Despite these complications, the overall successful outcome rate was high at 94%. These results suggest that while complications are inevitable in some cases, the majority of patients experience positive outcomes with proper surgical intervention and postoperative care.

Conclusion: These results underscore the effectiveness of using a simple fluoroscopic table and lateral decubitus positioning for managing femoral fractures, highlighting the advantages in visualization, ease of entry, and natural fragment reduction. The low incidence of complications and high rate of successful outcomes further support this method's utility in clinical practice. Also highlighting in need of augmentation (encerclage, hook plate or screw) plus in the case of revision surgery or broken implat removal, the ease of this position in almost every kind of femur fracture is unconditional.