Well-Leg Positioning on a Fracture Table: Using a Pillow Sling
Although rare, acute compartment syndrome remains a well-reported complication of the lithotomy position. The avoidable nature of this potentially devastating complication has led many surgeons to forgo this well-leg setup when using the fracture table, and instead place the uninjured limb into a scissored position.
In this report, we describe a safe and efficient technique for positioning the well leg in a scissored position on the fracture table using a pillow and a self-adherent compression bandage.
With this positioning method for the uninjured limb, an optimal amount of relaxed hip and knee extension, and limb adduction to midline along the table’s support bar, is reliably achieved to permit lateral fluoroscopic imaging of the injured limb without overlap of the well leg or interference with C-arm positioning.
With respect to compartment syndrome, there were no intraoperative or postoperative complications. Furthermore, no patients complained of pain in the well leg immediately after surgery or at subsequent follow-ups. No difficulty was encountered with intraoperative C-arm imaging of the injured limb at the hip or along the length of the femur in the lateral or anteroposterior planes. The well leg did not have to be repositioned in any cases to achieve adequate imaging of the hip and femur.
Discussion
Although rare, acute compartment syndrome remains a potential yet avoidable complication of the lithotomy position. Some surgeons avoid this setup of the well leg on the fracture table and instead use a scissored position for the uninjured limb.
In this report, we presented a safe and efficient technique for placing the well leg in a scissored position on the fracture table using a pillow and a self-adherent compression bandage. We did not compare the pillow-sling with other well-leg positioning techniques but instead described a reproducible technique that we have used effectively and successfully, even with multiple morbidly obese patients who met the weight limits for the fracture table.
In addition, even with consistent use of this pillow-sling technique at our high-volume trauma center, there have been no complications, such as compartment syndrome, well-leg pain, or difficulty in intraoperative imaging of the injured limb. The pillow-sling is a safe and expedient alternative technique for well-leg positioning on the fracture table, and it can be easily reproduced by other surgeons.
