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Proper Patient Positioning and Complication Prevention in Orthopaedic Surgery

Bonnaig, Nicolas MD; Dailey, Steven MD; Archdeacon, Michael MD, MSE

Journal of Bone & Joint Surgery - American Volume: 2 July 2014 - Volume 96 - Issue 13 - p 1135–1140
doi: 10.2106/JBJS.M.01267
Current Concepts Review

➤ The consequences of improper intraoperative positioning can be profound: it not only may cause substantial morbidity but also may be a major area of litigation, particularly when peripheral nerve injury occurs.

➤ The ulnar nerve is most likely to be injured secondary to improper positioning. The elbow should be flexed ≤90° and the forearm placed in a neutral or slightly supinated position intraoperatively to minimize pressure in the cubital tunnel.

➤ Pressure-related complications, such as pressure ulcers and alopecia, are best avoided by the use of adequate padding. Cushions on the operating-room table and armrest should be emphasized under osseous prominences.

➤ Positioning the head in a non-neutral alignment or arm abduction of ≥90° may result in injury to the brachial plexus.

➤ The hemilithotomy position increases intracompartmental pressure in the leg on the uninjured side. The risk of well-leg compartment syndrome can be minimized by avoiding this position if possible.

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2UC Health Department of Orthopaedic Surgery, University of Cincinnati College of Medicine, 231 Albert Sabin Way, ML 0212, Cincinnati, OH 45267-0212. E-mail address for S. Dailey:

Copyright 2014 by The Journal of Bone and Joint Surgery, Incorporated
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