Eighty patients with unstable intertrochanteric hip fractures undergoing operative fixation with an intramedullary nail were randomized to undergo surgery in the lateral decubitus position (n=40) or supine on a fracture table (n=40). The outcomes of interest included set-up, operative and fluoroscopy time, quality of fracture reduction and functional outcomes. The lateral decubitus group had a significantly shorter preparation and total anesthesia time. There was no difference in total operative time. The lateral decubitus group had significantly longer fluoroscopy time when compared to the supine group. There was no difference in the quality of fracture reduction or implant placement. Functional outcomes, as measured by the Harris Hip Score, were similar between groups at 1 year follow-up.