A New Technique for Patient Positioning during Olecranon Fixation
Kristin Sandrowski, MD; Eric M Padegimas, MD; Michael Rivlin, MD
Thomas Jefferson University Hospital, Philadelphia, PA
Introduction: Olecranonfracturesare common injuries of the upper extremity that frequently require operative fixation to restore elbow function. Surgery is often performed lateral or prone, presenting challenges for anesthesia and the surgical team to safely and appropriately position the patient. Prone and lateral positioning can be associated with increased complications in older patients, those with additional comorbidities or elevated body mass index. Supine positioning requires an assistant, the use of an arm board or table for appropriate exposure of the olecranon. We describe an easy and quick surgical set-up that provides good exposure to the operative site and stable positioning of the arm.
Technique: The patientis placed supine on the operative table with the body positioned slightly eccentrically with the operative arm hanging slightly over the edge of the bed. Two paint rollers are secured to the edge of the bed on the operative side, one above the arm and one below the arm, with tips touching forming a triangle. The arm is draped over paint rollers with elbow resting where the paint rollers meet (figure 1).
Figure 1 Figure 2
Next the arm is hung with finger traps to allow placement of a tourniquet with a10-10 drape as proximal as possible (figure 2). The arm is then cleaned and prepped. After the arm is prepped a sterile stockinet is placed over the arm followed by an impermeable and upper extremity drape. The stockinet is wrapped with ioban. Using an esmark the arm is exsanguinated and the tourniquet inflated. The arm is then drapped over the paint rollers and stockinet is cut to allow easy, direct access to the olecranon (Figure 3). To further secure the arm, the esmark is wrapped around the paint rollers, behind proximal humerus, and tied (figure 4).
Figure 3 Figure 4
The addition of the esmark allows the arm to stay in place during manipulation without requiring an assistant to hold. Once secure the olecranon is easily accessible for operative fixation and fluoroscopic evaluation (figures 5A&B).
Figure 5 A B
Appropriate positioning during operative fixation of the olecranon can be challenging and timely. Our technique allows for patients of different age, BMI and comorbidities to be positioned without the increased risks associated with prone and lateral positioning. Further this technique allows for simple, quicker operative set up and easy surgical and fluoroscopic access.
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