Mehmet BOZ, Abdullah Alper ŞAHİN

Lateral imaging technique of the femoral neck in a supine-semilithotomy position without a fracture table

Treatment of proximal femoral fractures in the supine position poses has certain challenges, especially due to difficulties in lateral imaging of the femoral neck in cases where there is no fracture table, such as prolonging the surgery time and increasing the dose of radiation exposure. The purpose of this study is to present the lateral imaging technique of the femoral neck by fluoroscopy on the conventional operating table in the treatment of proximal femoral fractures. We applied proximal femoral nail by positioning the healthy leg in a semilithotomy position to facilitate lateral imaging of the femoral neck by fluoroscopy while the patients were in the supine position. The study analyzed 22 patients (12 women, 10 men) with femoral pertrochanteric and basicervical fractures with the following types of fractures (9 patients had AO type 31-A1, 9 patients had AO type 31-A2, 4 patients had AO type 31-B2.1), and with a mean age of 62.1 years (33-75 years). The preparation time of the supine-semilithotomy position was about 2 minutes, and the reduction was finished within 9 intraoperative fluoroscopy exposure times. No patient suffered from a postoperative complication. The mean surgery time was 20 minutes (18-22 minutes), the average number of scopy shots was 8 (7-9), and the mean hospital stay duration was 2 days (2-2 days). We believe that the supine-semilithotomy technique is a suitable treatment option for proximal femoral intramedullary nailing and cannulated screw application. Since the lateral view of the femoral neck is obtained quickly and clearly with this technique, fluoroscopy does not need to be performed repeatedly, so fluoroscopy time and the number of shots are reduced, and the time spent by the patient and the surgical team in the surgery is shortened.

PDF

___

1. Egol KA, Koval KJ, Zuckerman JD. Handbook of fractures.Lippincott Williams & Wilkins 2010.

2. Kannus P, Sievänen H, Palvanen M, J et al . Prevention of falls and consequent injuries in elderly people. Lancet. 2005; 366:1885–93.

3. Canale ST, Beaty JH. Campbell’s operative orthopedics 12th ed, Canada: Elsevier Health Sciences; 2012.

4. Connelly CL, Archdeacon MT. The lateral decubitus approach for complex proximal femur fractures: anatomic reduction and locking plate neutralization: a technical trick. J Orthop Trauma. 2012;26:252-7.

5. Callanan I, Choudhry V, Smith H. Perineal sloughing as a result of pressure necrosis from the traction post during prolonged bilateral femoral nailing. Injury. 1994;25:472.

6. Kao JT, Burton D, Comstock C, et al. Pudendal nerve palsy after femoral intramedullary nailing. J Orthop Trauma. 1993;7:58-63.

7. Ozkan K, Cift H, Akan K, et al. Proximal femoral nailing without a fracture table. Eur J Orthop Surg Traumatol. 2010;20:229-31.

8. Lin J. Encouraging results of treating femoral trochanteric fractures with specially designed double-screw nails. J Trauma. 2007;63:866–74.

9. Jin L, Zhang L, Hou Z, et al. Cephalomedullary fixation for intertrochanteric fractures: an operative technical tip. Eur J Orthop Surg Traumatol. 2014;24:1317–20.

10. Lee YK, Chung CY, Park MS, et al. Intramedullary nail versus extramedullary plate fixation for unstable intertrochanteric fractures: decision analysis. Arch Orthop Trauma Surg. 2013;133:961–8.

11. Crawford CH, Malkani AL, Cordray S, et al. The trochanteric nail versus the sliding hip screw forintertrochanteric hip fractures: a review of 93 cases. J Trauma. 2006;60:325–8. (discussion 328–9).

12. Zhao Z, Song F, Zhu Jet al. Prone positioning for intramedullary nailing of subtrochanteric fractures, the techniques of intraoperative fluoroscopy and reduction: A technique note. Injury. 2017;48.2354-9.

13. Bishop JA, Rodriguez EK. Closed intramedullary nailing of the femur in the lateral decubitus position. J Trauma. 2010;68:231-5.