Lateral decubitus position

Lateral decubitus positioning may be used for posterior arthroplasty approaches and access to the femoral head and posterior wall of the acetabulum.

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

• Site and side of the fracture
• Type of operation planned
• Ensure that the surgeon has marked the operative site
• 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

Routine perioperative care includes:

• Brief intravenous antibiotics
• VTE prophylaxis (before, during, and after surgery)
• Nutritional supplementation
• Pain management without oversedation
• Prevention of pressure sores
• Early mobilization
• Early discharge planning
• Osteoporosis evaluation and management

For more details, see the additional material on perioperative care for elderly hip fracture patients.

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

Place the patient in a lateral position with the ipsilateral arm in an arm sling or on pillows.

Place padded cushions under bony prominences to avoid excessive pressure.

Before draping, make sure proper image intensifier view in both AP and lateral directions can be obtained.

Axial views may be difficult to obtain.

C-arm position for lateral view 

During the operation, some centers provide VTE prophylaxis with sequential mechanical compression on the contralateral leg.

Disinfect the exposed area from above the iliac crest to the mid-tibia with the appropriate antiseptic solution.

Free drape the affected limb with a single-use U-drape. Cover the lower leg and knee with a stockinette and fix it with tape. Drape the leg to be freely moved.

Drape the image intensifier.

The surgeon, an assistant, and ORP stand behind the patient. An assistant stands on the contralateral side of the table.

Place the image intensifier on the opposite side of the surgeon.

Place the image intensifier display screen in full view of the surgical team and the radiographer.