Closed intramedullary nailing of the femur in the lateral decubitus position.

Closed intramedullary nailing is the standard of care for femoral shaft fractures and the technique now has broader applications with the proliferation of cephalomedullary instrumentation for the treatment of intertrochanteric and subtrochanteric femur fractures. Nailing in the lateral decubitus position has several advantages, but we are unaware of a detailed, contemporary description of the surgical technique published in the English language literature.A retrospective review of 158 patients treated with intramedullary nailing in the lateral position by a single surgeon over a 3-year period was performed. Clinical and radiographic outcomes were evaluated. In a group of 58 diaphyseal femur fractures, there were three rotational malreductions and one limb length discrepancy that required operative intervention. All but one were recognized and corrected intraoperatively on placing the patient supine. In a group of 100 primarily geriatric intertrochanteric, subtrochanteric, or peritrochatneric fractures managed with a cephalomedullary device, there were two lag screw cutouts, one nonunion, and one hardware failure. All of these required revision surgery. There were no rotational or length malreductions that required correction. There were no injuries to the perineum or contralateral leg, nerve palsies, or traction-related complications. Lateral positioning obviates the need for a fracture table, makes it easier to establish a starting point for an intramedullary device, and facilitates conversion to an open procedure without repositioning should this become necessary. This study demonstrates that the technique is safe and effective with an incidence of complications comparable with fracture table and supine positioning.