Supine with manual traction
This positioning is recommended for bilateral fractures because it can allow for the reduction and fixation of both fractures without requiring re-draping. However, the axial view may be difficult to obtain because elevation of the contralateral leg is required.
Lateral decubitus position
This position is recommended for very proximal fractures because finding the nail entry-point is easier. However, it is more time consuming and iatrogenic injuries to the pudendal nerve have been documented, due to prolonged or excessive traction. This position is also recommended for obese patients.
Supine knee flexed 30°
This position is useful for antegrade nailing or retrograde nailing as the ability to obtain AP and lateral X-rays is exceptional.
Scissoring makes length, alignment and rotational confirmation easy. Raising the injured leg facilitates reduction of any flexed proximal fragment (iliopsoas muscle).