Lateral Versus Modified Tilted Supine Position of Patients Undergoing Peritrochanteric Fracture Fixation By Dynamic Hip Screw: A Randomized Controlled Trial

Abstract

Introduction: The study aimed to prospectively compare the lateral and the modified tilted supine position in patients undergoing trochanteric fracture fixation using dynamic hip screws regarding the procedural difficulties and the radiologic outcomes. Materials and Methods: This randomized controlled trial recruited 64 patients with peritrochanteric fractures; 30 in group A, where patients were placed in a supine position on the operative table and 34 in group B, where patients were placed in a lateral position. Our outcome measure were the setting-up time, operating time, any operative difficulties, preoperative blood loss, postoperative wound drainage, and the amount of blood transfused. Hemoglobin levels before and at 48 hours after surgery, delay in wound healing or infection, and duration of hospital stay were noted. Radiologically, the amount of displacement, femoral neck-shaft angle (NSA), tip-to-apex distance (TAD), and modified Parker Index Ratio (PIR) were measured and reported. Patients were followed up for a minimum of 2 years. Results: The mean setting-up time was significantly shorter in the lateral position group (B). The mean fluoroscopy time was significantly longer among the supine position group (A). However, the total operative time was similar in both groups. The mean NSA in the anteroposterior view was similar in both groups. The disparity between the diastasis in both AP and lateral views was substantially higher among group B. Both groups had close PIR in both AP and lateral views and TAD at final follow-up. Conclusions: This study demonstrates that the lateral position provides shorter setting-up, fluoroscopy and operative times for peritrochanteric fracture fixation (AO types 31A1 and 31A3) using a dynamic hip screw. This highlights its potential to enhance surgical success and patient recovery. Level of Evidence: Level I.