Proximal Femoral Nail Anti-rotation in the Lateral Decubitus Position for Unstable Reverse Oblique Intertrochanteric Fracture: A Case Report

DOI

10.2991/978-94-6239-836-8_6How to use a DOI?

Keywords

Intertrochanteric proximal femur fracture; reverse oblique; AO 31A3; intramedullary PFNA; proximal femoral nail antirotation; lateral decubitus

Abstract

Intertrochanteric femur fractures are among the most common hip injuries in the elderly population, accounting for nearly half of all proximal femoral fractures. Unstable patterns, particularly reverse oblique fractures (AO/OTA 31A3), present a biomechanical challenge that is poorly controlled by extramedullary devices, making intramedullary fixation with the Proximal Femoral Nail Antirotation (PFNA) the preferred treatment. This case report describes the management of a 69-year-old male presenting with a right-sided closed reverse oblique intertrochanteric femur fracture (AO/OTA 31A3) following a low-energy bathroom fall. The patient was successfully treated with closed reduction and internal fixation (CRIF) using PFNA in the lateral decubitus position without a fracture table. Theoretical and technical aspects of the lateral decubitus approach are discussed, including advantages in entry-point identification, C-arm visualization, and avoidance of traction-related complications. Satisfactory fracture reduction and implant positioning were achieved with acceptable post-operative radiographic outcomes. The lateral decubitus position represents a viable and potentially superior alternative for PFNA surgery, particularly in centers without a dedicated orthopaedic fracture table.

Copyright

© 2026 The Author(s)

Open Access

Open Access This chapter is licensed under the terms of the Creative Commons Attribution-NonCommercial 4.0 International License (http://creativecommons.org/licenses/by-nc/4.0/), which permits any noncommercial use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license and indicate if changes were made.

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TY  - CONF
AU  - Muhammad Bayu Rizaldy
PY  - 2026
DA  - 2026/11/11
TI  - Proximal Femoral Nail Anti-rotation in the Lateral Decubitus Position for Unstable Reverse Oblique Intertrochanteric Fracture: A Case Report
BT  - Proceedings of the3rd Malikussaleh International Conference on Health and Disaster Medicine 2026  (MICOHEDMED 2026)
PB  - Atlantis Press
SP  - 49
EP  - 57
SN  - 2468-5739
UR  - https://doi.org/10.2991/978-94-6239-836-8_6
DO  - 10.2991/978-94-6239-836-8_6
ID  - Rizaldy2026
ER  -