Supine patient position on a radiolucent table

Supine patient positioning is used for most of the surgical management of trochanteric and femoral neck fractures. The use of a radiolucent table allows for intraoperative manipulation of the leg. The contralateral thigh can interfere with lateral image intensifier views. A hemilithotomy or lifting the contralateral limb while taking the lateral view may be helpful.

$Supine patient position on a radiolucent table for surgical treatment of proximal femoral fractures$

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 supine and as close as possible to the edge of the table.

Lift the pelvis with a folded sheet under the ipsilateral buttock and tilt the table. A lateral support at the level of the contralateral iliac crest is required to prevent the pelvis from migrating to the contralateral side.

For optimal lateral and axial views, the patient may be positioned in a hemilithotomy (contralateral leg in a leg holder).

$Supine patient position on a radiolucent table for surgical treatment of proximal femoral fractures$

With the table tilted, the AP image can be obtained with a vertical beam.

For a lateral and axial view, roll the C-arm under the table. The beam track should avoid the contralateral hip.

Supine patient position on a radiolucent table with the C-arm positioned for a lateral view of the proximal femur

Position the patient in a hemilithotomy (contralateral leg in a leg holder) to obtain optimal lateral and axial views.

Supine patient position on a radiolucent table with the contralateral leg in a leg holder and the C-arm positioned for a lateral view of the proximal femur

For undisplaced fractures, the surgeon can proceed with skin preparation and draping and then on to exposure for fixation. If the fracture is displaced, closed reduction should be carried out at this point. If it is unsuccessful, percutaneous manipulation or formal open reduction will be necessary, and the incision must be planned appropriately.

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

$Supine patient position on a radiolucent table with the contralateral leg in a leg holder and VTE pump for surgical treatment of proximal femoral fractures$

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

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 solution.

Free drape the affected limb(s) with a single-use U-drape. A stockinette covers the lower leg and is fixed with tape. The leg is draped to be freely moved.

Drape the image intensifier.

$Skin disinfection and free draping of a patient position on a radiolucent table for surgical treatment of proximal femoral fractures$