- Supine position for nailing
Generally, a fracture table will be used to reduce and fix these
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 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.