PMC4429807_01
(a) Radiograph of the femur showing a comminuted, spiral fracture over the shaft before operation; and (b) a satisfactory fixation was obtained after a lengthy closed femoral nailing
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Fig1
A 28-year-old female (body mass index of 20.2 kg/m2) sustained a comminuted, spiral fracture over her right femur in a motor vehicle accident (Fig. 1a). Because of technical difficulties in aligning fragments closely as well as in locking distal static screws, it took four hours to obtain a satisfactory fixation (Fig. 1b).
A supine hemilithotomy position in authors' institute is routinely maintained with a boot immobilization and patients' knee flexed over 90  instead of a calf supporter or a suspension knee strap, making the posture of the non-operated limb similar to squatting
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Fig2
Tuttlingen, Germany). The patient underwent these surgical procedures under general anesthesia, and was kept in a supine hemilithotomy position- the non-operated leg was held by a boot and positioned in 80  of hip flexion, 30  of abduction, and 105  of knee flexion without any leg holders or fixation straps around the knee (Fig. 2).