Individualized fluoroscopic lateral femoral neck view for fixation of hip fractures in the lateral decubitus position

Aims: The aim of this study is to evaluate whether displaced hip fractures can be reduced and nailed properly in the lateral decubitus position without using a traction table with Proximal Femoral Nail Antirotation as a fixation device with inlet flouroscopic view. Methods: In this retrospective study, 58 patients with hip fractures who were treated with Proximal Femoral Nail Antirotation in a single center were evaluated to determine the efficacy of the inlet fluoroscopic image. The postoperative X-rays of the patients underwent a comprehensive evaluation including the tip-apex distance, the quality of fracture reduction, and the positioning of the screw. The length of hospital stay, postoperative, and total hospital stays were evaluated. We propose personalized fluoroscopy positioning method for the reduction and internal fixation of hip fractures, eliminating the need for a traction table. Results: The mean age of the patients was 78.43±11.67 years. By inlet viewing of the hip the most common placement of the integrated compression screws on postoperative radiographs was found to be 63.8% in Cleveland zone 5 and an increase in the femoral neck angle mean was 133,6° resulted in a significant decrease in the postoperative hospital stay of which mean was 3.95 days . The tip-apex distance was 19 mm as a mean. Conclusion: The nailing of proximal femoral fractures using a lateral decubitus position and neutral fluoroscopy view may not achieve optimal quadrant placement of the nail. However, by repositioning the C-arm fluoroscopy with a 45-degree inlet angulation from the initial reference point, aligned with the femur and considering individual adduction, an enhanced lateral visualization of the femoral neck can be achieved, which will also help reduce potential complications during surgery.

Keywords:

Flouroscopy, hip fracture, lateral decubitus position proximal femoral nailing,

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