Peter Kloen, David Ring
Peter Trafton, Michael Baumgaertner
The majority of patients with isolated proximal forearm fracture can be positioned supine, with the arm across the chest, posterior exposure is enhanced.
Operating room personnel need to know and confirm:
The procedure is performed with the patient under general anesthesia.
While technically possible, regional anesthesia is not advised as the procedure can be prolonged.
Place the patient supine on a radiolucent table with the shoulder adducted and the elbow flexed across the torso, stabilized by an assistant, a well-padded arm rest, or a cushion (as illustrated).
Pillows or cushions to tilt the torso towards the opposite side will help keep the injured arm over the chest.
Take extreme care to protect the patient’s face and eyes before skin disinfection.
Adjust the operating table to the appropriate height.
Place the image intensifier screen opposite the surgeon on the other side of the table. Make sure intra-operative fluoroscopy can be obtained both in AP and lateral direction.
Use of a sterile tourniquet is determined by surgeon’s preference.
After positioning the patient, disinfect the entire upper limb with the appropriate antiseptic.
Drape the upper arm, including the tourniquet. If a sterile tourniquet is used it is applied after draping.
Drape the hand separately to allow elbow flexion during surgery and imaging.
Complete patient draping using single-use drapes or sterile sheets.
Drape the image intensifier.