Supine position with manual traction

The patient is positioned supine on a conventional table and moved as close as possible to the edge of the table. The pelvis is lifted up by a folded sheet under the ipsilateral buttock.

Note: for periprosthetic fractures, whether performing ORIF or revision arthroplasty, it is preferred to position the patient on a radiolucent table.

Operating room personnel (ORP) need to know and confirm:

Site and side of fracture
Type of operation planned
Ensure that operative site has been marked by the surgeon
Condition of the soft tissues
Implant to be used
Patient positioning
Details of the patient (including a signed consent form and
appropriate antibiotic and thromboprophylaxis)
Comorbidities, including allergies

This procedure is performed with the patient under general or regional anesthesia.

Reconfigure the table or transfer the patient to a fracture table.
Reduce the fracture with manual traction and manipulation to ensure reduction is possible before preparing and draping the patient.
Pad all pressure points carefully (especially in the elderly).
Position the image intensifier on the opposite side of the injury and the operating surgeon
Ensure that you can get good-quality AP and lateral x-ray views of the fracture site, full prosthesis, and distal femur before draping.
In obese patients it may be technically easier to perform the surgery on a lateral position on a radiolucent table.
Adduct and slightly flex the affected leg anteriorly in front of the unaffected one to ensure the position is reasonable for obtaining X-rays.
A firm cushion placed in the midline beneath the pelvis may be used to elevate the pelvis from the table edge and facilitate the skin incision.
The ipsilateral arm should not be positioned on an arm board or abducted, since it could interfere with the surgical procedure. An adducted (pictured) or elevated position is favored.
The surgeon must be satisfied with the position before the patient is prepared for surgery.

Maintain light manual traction on the limb during preparation to avoid excessive deformity at the fracture site.
Disinfect the exposed area from above the iliac crest to the mid-tibia with the appropriate antiseptic.
Free drape the affected limb(s) with a single-use U-drape. A stockinette covers the lower leg and is fixed with a tape. The leg is draped to be freely moved.
Drape the image intensifier.

Draping for a patient in supine position

The surgeon, assistant, and ORP stand on the side of the injury.
Place the image intensifier on the opposite side of the injury or surgeon.
Place the image intensifier display screen in full view of the surgical team and the radiographer.