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available shape-conforming hip positioning pad (The Pink Hip Kit®; Xodus Medical) and a standard traction system was used. The arms were positioned on specific armrests. Figure 1 Patient positioned with The Pink Hip Kit® The operating table was placed in Trendelenburg based on the patient’s sex, height, weight and fracture type. The Trendelenburg position was used to increase friction between the patient and the pad, allowing a stronger distraction. The unaffected leg was padded and flexed 90° at the hip and placed in abduction and external rotation on a common leg holder. Bony prominences of the foot and ankle of unaffected leg were padded. The upper trunk was flexed toward the opposite side for easy nail introduction. When the patient was in the correct position, the C-arm fluoroscopy was placed in order to obtain lateral and anterior-posterior view along the whole length of the femur. When positioning was completed (Figure 1), fractures were reduced according to their specific morphology with the most appropriate combination of traction, abduction and rotation; then the affected leg was prepared and draped. Femur fixations were performed with long femoral nails according to standard surgical technique8. At the end of surgery, traction was removed. Subsequently, if necessary, a conversion of the external fixation of the pelvic injuries was performed with 6.5mm cannulated iliosacral screws and pubic plates on the same surgical table. Standard technique was used as previously described9. All five patients we included in this study from October 2018 had a type C fracture with Tile classification10. We had four diaphyseal fractures of the femur (AO/OTA 32 A1b, AO 32 B2b) while only one sub-trochanteric one (AO/OTA 32 A2a)11. After the procedure, the quality of the femoral reduction was anatomical in four cases, satisfactory in one case. Fortunately, no allergic reactions to the pad were reported. The results were excellent in terms of complications: no patients developed new perineal skin injuries after surgery obtaining a perfect and good reduction in four and one fracture respectively. Even though it was not a very large sample, we can say we achieved the desired distraction and a good reduction in five cases with no perineal disfunction directly caused by the surgery. 21