- Supine position for nailing
Generally, a fracture table will be used to reduce and fix these fractures.
Place the patient in a supine position.
The contralateral leg should be positioned in a way that it is convenient for both patient and surgeon. Depending on the medical history (eg contralateral hip prosthesis) this leg should be positioned so that it is not harmed and that image intensification is easily accessible. The ipsilateral arm is placed in arm sling.
The ipsilateral leg should be in an adduction position in the hip. This position can be achieved by moving the torso to the contralateral side as conveniently as possible. Before starting make sure that image intensification of the whole hip joint in two directions is not hampered in any way. Traction is applied to the leg according to the type of fracture table but generally with a "shoe traction“ device.
It is essential that the C-arm is positioned in such a way as to provide good images of AP, axial, and lateral views of the femoral neck and diaphysis respectively. With the patient and fluoroscope properly positioned, obtain AP and lateral images.
For undisplaced fractures, the surgeon can proceed with skin preparation and draping, and then on to exposure for fixation. If the fracture is displaced, closed reduction should be carried out at this point. If it is unsuccessful, percutaneous manipulation or formal open reduction will be necessary and the incision must be planned appropriately.