This position is helpful for all procedures involving the toes, metatarsals, and the midfoot.
Careful pre-cleaning of the soft tissues should be performed, especially if gross contamination occurs.
Operating personnel need to know and confirm:
This procedure is performed with the patient under general or regional anesthesia.
If a spinal anesthetic is used, the surgeon and anesthetist need to be confident that the procedure will last the duration of the anesthetic.
Long-acting pain blocks for the injured leg should be avoided if there is a risk of compartment syndrome, as this could hide symptoms of a subsequent compartment syndrome.
Perioperative antibiotics are required for all open procedures. The standard first-generation cephalosporin is given before surgery and may be readministered for up to 24h. Antibiotics are administered according to local antibiotic policy and specific patient requirements.
Many surgeons use a Gram-positive prophylactic antibiotic cover for closed fractures, adding Gram-negative prophylactic coverage for open fractures.
Thigh or calf tourniquets can help minimize blood loss and improve the view of the articular surface. In the trauma patient, the surgeon must consider the effects of ischemia/reperfusion and the potential effects of tourniquet use in the presence of a compromised soft-tissue envelope and compromised vascular supply.
Consideration of tourniquet use should be part of the preoperative planning process.
The tourniquet should not be left on longer than 120 minutes and shorter in older patients or those with known vascular disease.
Disinfect the expected operating field, including the entire foot, with the appropriate antiseptic.
The surgeon and the ORP stand at the end of the bed. The assistant stands next to the surgeon.
Place the display screen in full view of the surgical team and the radiographer.