- Supine position (fracture table)
The patient is positioned supine on the fracture table. The ipsilateral arm is elevated in a sling while the contralateral uninjured leg is placed on a leg holder. This position is well suited for excellent true AP and cross-table lateral x-rays.
In 31-B1 fractures it is important to transfer the patient with great care from bed to operation table in order to avoid disimpaction of the fracture. Do not apply traction! In the non-impacted fracture types B2 and B3, this advise is not applicable.
An image intensifier is required for reduction on the traction table. With the patient and fluoroscope properly positioned, obtain AP and lateral images.
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.