Supine with legs scissored on the fracture table (Figure 20-1)

Bump underneath ipsilateral pelvis with ipsilateral arm draped over a pillow on chest

Assure that the trochanteric region is easily accessible

Avoid malrotation of foot

Fluoroscopic view to make sure adequate visualization of hip, fracture, and knee

Lateral on the radiolucent fracture table (Figure 20-2)

Assure fluoroscopic visualization of hip and fracture

Lateral approach to proximal femur depending on the extent of exposure needed

Skin incision, followed by longitudinal split of the IT band

Elevate the vastus by making a horizontal cut with electrocautery on anterior femur at vastus insertion followed by elevation of the vastus off the posterior intermuscular septum leaving minimal muscle cuff to avoid perforating septum. Coagulate perforators (Figure 20-3).

More extensive dissection versus less dissection will depend on the procedure. Extensive dissection needed with open plating versus selective exposure to control fracture fragments with intramedullary nailing.

All reduction techniques rely on the understanding of muscle forces on the proximal fragment which will tend to be flexed (iliopsoas), abducted, and externally rotated (gluteus, short external rotators)