Does supine versus lateral position affect operative time and reduction quality for elderly intertrochanteric femur fractures?

To compare operative time, reduction quality, and implant placement between supine and lateral decubitus positions for cephalomedullary nailing (CMN) of intertrochanteric fractures in elderly patients. A retrospective review was conducted of patients aged ≥ 60 years with intertrochanteric fractures treated with CMN at a Level I trauma center over one year. Patient demographics, injury characteristics, and operative details were recorded. Procedures were performed on either a traction table or flat-top table. The primary outcome was total operating room (OR) time. Secondary outcomes included setup time, surgical time, reduction grade, tip-apex distance, implant placement, blood loss, fluoroscopic exposure time, fluoroscopic radiation dose, and postoperative complications. 54 patients positioned supine and 29 positioned lateral decubitus were included. No differences were observed between groups regarding patient and injury characteristics, including operating table type (p > 0.05). Lateral group, compared to supine group, had significantly greater total OR time (218.2 ± 60.8 vs. 162.8 ± 45.4 min, p < 0.001), setup time (90.9 ± 21.5 vs. 64.1 ± 21.2 min, p < 0.001), surgical time (114.5 ± 43.4 vs. 85.8 ± 33.4 min, p < 0.001), and fluoroscopic radiation dose (13.5 ± 13.8 vs. 6.1 ± 3.7 Gy·cm2, p < 0.001). There was no significant difference in reduction grade, implant placement measures, blood loss, fluoroscopy time, or postoperative complications (p > 0.05). On multivariate regression, lateral positioning was significantly associated with increased total OR time (β = 42.17, p = 0.004), setup time (β = 21.55, p < 0.001), surgical time (β = 21.18, p = 0.040), and radiation dose (β = 6.37, p = 0.009). Supine positioning for CMN of intertrochanteric fractures in elderly patients was associated with shorter operative time compared to lateral positioning, with no difference in reduction quality or implant placement.