Intertrochanteric Nailing Without a Traction Table: A Practical Positioning Technique on a Standard Operating Table

Intertrochanteric femur fractures often require cephalomedullary nailing, yet many centers, particularly those in resource-limited settings, lack traction tables. This technical note introduces a novel positioning method that enables safe and reproducible intramedullary fixation on a standard radiolucent operating table with a central post, a configuration for which practical guidance is limited in the literature. The technique uses caudal table translation, 15-20° ipsilateral sacral elevation, and 40-50° contralateral limb lowering to achieve adequate anteroposterior and lateral fluoroscopic visualization without specialized equipment. This approach is intended for orthopedic surgeons working in hospitals with restricted infrastructure, offering improved ergonomics, reliable imaging, and efficient workflow. Potential challenges, including limited leg support, fluoroscopic overlap, and contamination risk during under-table imaging, can be minimized with appropriate preparation. The method provides a practical alternative for centers without traction tables and expands operative feasibility in equipment-constrained environments.