Objective: To compare two positioning approaches in the surgical treatment of unstable intertrochanteric femoral fractures fixed by proximal femoral nailing, the supine versus lateral decubitus position Methodology: This randomized prospective comparative study on 26 patients with unstable intertrochanteric fractures was carried out from January 2020 and June 2022. We randomly divided patients into two groups: group A (13 patients) were operated using the traction table in the supine position for implant insertion, and group B (13 patients) were operated using the lateral decubitus position. We compared both groups regarding the setup time, operative time, tip-to-apex distance, collodiaphyseal angle, time for fluoroscopic time exposure, and radiologic reduction of the fracture using Chang criteria. Results: The setup, fluoroscopic exposure, and surgical times were shorter in the lateral decubitus group with statistical significance. The collodiaphyseal angles, the tip-to-apex distance, and the radiological fracture reduction were not significantly different between two groups. Conclusions: The lateral decubitus positioning is superior to the supine position in setup, fluoroscopic exposure, and surgical times
