The most commonly used patient position is supine with the arm either on an arm table, or directly on the draped C-arm. This position can be used for the majority of pediatric fractures of the distal humerus, both supracondylar and articular.
The patient is positioned with the fractured extremity as close as possible to the edge of the table. To prevent the child from falling down from the operating table during reduction/manipulation. Side support is recommended.
Note: Care should be taken that the upper body is not supported by the arm table especially in younger children with a short arm. Great care must be taken to avoid extremes of neck positioning.
Pearl: Very small/young children (up to 5-6 years) can additionally be fixed using a towel around the thorax that is attached to the contralateral side of the table.
There are two possible positions for the C-arm:
Note: After reduction has been achieved, the arm should be moved as little as possible. Images should be obtained by rotating the C-arm and not moving the arm.
There are two options for positioning of the extremity in relation to the C-arm:
When the preoperative reduction of a supracondylar fracture is undertaken unsterile with minimal assistance, the following steps can be taken:
Note: The disadvantage of this position is that the fracture position cannot be altered during the remainder of the procedure.