- Abducted contralateral leg
Supine positioning with abducted contralateral leg
The patient is positioned supine with the contralateral leg flexed and abducted. Care should be taken to cushion the abducted leg in order to prevent peroneal nerve injury. In addition, excessive abduction should be avoided in order to lower the risk of pressure-induced compartment syndrome.
A support underneath the ipsilateral buttock may be useful for facilitating the approach particularly in obese patients.
The ipsilateral arm should not be positioned on an arm board or abducted since it would interfere with nail insertion. An adducted (pictured) or elevated position is favored.
The contralateral leg should be well padded and positioned without pressure on to the calf in order to prevent peroneal nerve damage or calf muscle compartment syndrome.
In case of nailing, adduction of the operated limb facilitates entry point localization.
This positioning is advantageous because it allows a straight lateral x-ray beam for the distal locking.
If the C-arm is positioned between the injured and uninjured legs, both AP and lateral views can be obtained easily. Some surgeons prefer the use of two C-arms.
Here, the ipsilateral arm is in an elevated position.
Positioning of second C-arm
The use of a second C-arm can be beneficial and should be considered in those centers where there is the capacity to use two C-arms simultaneously.
If available, the second C-arm can be positioned as shown in this image.