Authors of section

Authors

Arnold Besselaar, Daniel Green, Andrew Howard

Executive Editor

James Hunter

General Editor

Fergal Monsell

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Patient preparation in supine position

1. Preoperative preparation

Read the additional material on preoperative preparation.

2. Anesthesia

  • General anesthesia
  • Local nerve block in addition to pain management
  • Combination of nerve block and light general anesthesia

3. Prophylactic antibiotics

Antibiotics are administered according to local antibiotic policy and specific patient requirements.

Many surgeons use Gram-positive prophylactic antibiotic cover for operative management of closed fractures, adding Gram-negative prophylactic cover for open fractures.

4. Patient position

Place the patient supine on a radiolucent table.

A small support on the ipsilateral buttock may help to stabilize the pelvis during the procedure.

If necessary place a support under the knee to relax the gastrocnemius muscle and reduce the deforming forces on the distal femur.

Supine patient position

5. C-arm positioning

The C-arm comes in from the uninjured side.

Set up the C-arm to allow AP and lateral views without moving the leg.

Either lower the contralateral leg or raise the injured knee to obtain lateral views.

C-arm positioning

6. Skin preparation and draping

Prepare the entire leg including the foot.

Drape the entire leg up to the pelvis.

Skin preparation and draping

7. OR set-up

The optimal position of the surgeon is on the injured side of the patient.

The position of the screen should allow a direct view for the surgeon.

OR set-up