Prepare the limb from the ankle to the groin and drape the foot which will allow free mobility of the whole limb. Place a sterile pack under the knee to maintain 30 degrees of flexion. At times full extension of the knee may be necessary to reduce traction on the patellar ligament.
The use of a tourniquet is necessary in open and direct reduction of articular fractures.
It is also helpful in open direct reduction and screw and plate fixation. It is not necessary whenever MIPO techniques are employed. It is contraindicated for the insertion of external fixator pins, in intramedullary nailing, and under most circumstances when dealing with open fractures.
C-arm positioning must allow for perpendicular images of the plateau, especially accounting for the posterior slope of the proximal tibia. As well a true lateral image must be easily obtainable. The C-arm should be placed on the non-injured side of the patient.