Lateral decubitus position

This position may be useful depending on the patient's anatomy and other comorbidities.

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

• Site and side of the fracture
• Type of operation planned
• Ensure that the operative site has been marked by the surgeon
• Condition of the soft tissues (fracture: open or closed)
• 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

Long-lasting postoperative complete pain blocks for the patient with injured leg should be avoided as this could hide symptoms of a subsequent compartment syndrome.

• Ensure that all bony prominences are adequately padded.
• Ensure that the contralateral limb is positioned so that when fluoroscopic imaging is used during surgery, it is not superimposed with the injured limb.
• In many instances, it may be optimal for the patient to be in a semi-lateral decubitus position to allow for appropriate reduction techniques (access to the medial distal femur)
• Position the image intensifier on the opposite side of the injury and the operating surgeon.
• Place the image intensifier display screen in full view of the surgical team and the radiographer

• Ensure that you can get good-quality AP (illustrated) and lateral x-ray views of the distal femur before draping.

• Maintain 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 foot with the appropriate antiseptic.
• Ensure that surgical access exists from the proximal femur to the midshaft of the tibia
• Place the image intensifier on the nonsterile side of the exclusion drape.
• Traditional drapes may be used. Ensure a waterproof environment for the operative site.
• Drape the image intensifier.

• Position the operating table (if feasible) within the operating room to allow maximum space on the operating side for the surgeon, staff, and trolleys.
• The surgeon and the ORP stand on the side of the injury. The Assistant may be on either side.
• Place the image intensifier on the opposite side of the patient, perpendicular to the patient.
• Place the image intensifier display screen in full view of the surgical team and the radiographer