Femoral shaft fractures are among the most common long bone fractures, often occurring most frequently in young males after high-energy trauma such as motor vehicle accidents and in elderly females after falls from standing. Incidences of such fractures have been found to be increased due to increasing population and use of motor vehicles. The majority of adult femur fractures are treated surgically with intramedullary nailing regarded as the gold standard treatment for management. Despite its widespread use, the success of femoral nailing procedures is influenced by several factors, including the patient’s positioning during surgery.

Two primary positions are commonly employed during femoral nailing: the lateral decubitus position and the supine position. Each position has its advantages and disadvantages. The supine position is favoured for familiarity among surgical teams. Conversely, the lateral position is preferred by some surgeons for its potential benefits in specific fracture patterns, such as proximal or distal femur fractures, due to improved mechanical alignment and access. In the lateral decubitus position, finding the trochanteric entry site, ensuring reduction, and placing the apical and distal locking screws can be done more easily and quickly. Lateral positioning is preferred in sub-trochanteric femur fracture and in obese patients for the ease of reduction and making entry. Since it can be done on simple OT table, hence cost effective and can be done at any centre where they lack fracture table.