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

PURPOSE: 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. METHODS: 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. RESULTS: 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). CONCLUSION: 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.