A Novel C-arm Rotation and Limb-Positioning Algorithm to Obtain a Reliable Lateral Femoral Neck View in Lateral Decubitus Intertrochanteric Fracture Fixation

This study aimed to evaluate the feasibility of proximal femoral nailing (PFN) in the lateral decubitus position using a standardized, limb-based approach without a traction table and to report early postoperative (24-72 hours) radiographic and technical outcomes, focusing on lag screw position and tip- apex distance (TAD). This single-center retrospective study included 52 adult patients (>18 years) who underwent PFN in the lateral decubitus position according to a standardized algorithm between January 2021 and December 2024. Demographic characteristics, fracture classification, operative parameters, early postoperative (24-72 hours) radiographic measurements (TAD and Cleveland-Bosworth quadrant position), and postoperative complications recorded during available follow-up were collected. Evans and Boyd-Griffin classifications were used for fracture typing. Statistical analyses evaluated the association between fracture stability and operative duration; analyses involving cut-out were interpreted descriptively due to the low event count. The mean age was 70.5 ± 13.4 years, and 59.6% of patients were male. According to the Evans classification, 69.2% of fractures were stable, 23.1% were unstable, and 7.7% were reverse oblique. The mean operative preparation time was 10.4 ± 1.8 minutes, and the mean operative duration was 43.6 ± 7.9 minutes; operative duration was longer in unstable fractures (p < 0.001). According to the Cleveland-Bosworth system, 73.1% of lag screws were positioned central- central, and no screws were placed in the superior-posterior quadrant. The mean TAD was 17.7 mm, and 96.2% of patients had TAD < 25 mm. Cut-out occurred in two patients (3.8%) and was observed among patients with higher TAD values; this observation was considered exploratory. We present a novel standardized, limb-based lateral decubitus PFN algorithm without a traction table. The approach yielded reproducible early postoperative radiographic parameters (24-72 hours), including acceptable TAD values and favorable Cleveland-Bosworth screw placement.