Prone position

The following are essential for successful surgery:

• Patient information
• Operating room personnel (ORP) information/instruction
• Surgical planning

Before treatment discuss the following information with the patient/parents/carers:

• Nature of the injury
• The chosen treatment and why a particular treatment is selected
• Alternative treatments
• General operative risks
• Expected healing time
• Functional recovery
• Implant removal

Operating room personnel (ORP) need to know and confirm:

• Consent form, completed and signed
• Site and side of fracture
• Type of operation planned
• Surgical approach
• Operative site has been marked by the surgeon
• Condition of soft tissues
• Equipment/implants needed
• Patient positioning
• Duration of operation
• Positioning of image intensifier
• Antibiotic prophylaxis
• Comorbidities, including allergies

The surgeon should make sure that:

• Relevant x-rays and other images are available in the OR.
• Required instruments and implants are accessible and ready.
• Tourniquet is available (a sterile tourniquet makes draping more straightforward).
• Image intensification is available.
• Intraoperative x-ray documentation should be undertaken, with clear AP and lateral views, before applying any plaster cast.
• There is a clear, step-by-step plan of the operation, including backup plans.

• General anesthesia
• Local nerve block
• Combination of nerve block and light general anesthesia
• Prophylactic antibiotics (see local microbiological protocols.)

Position the patient prone with the forearm hanging free supported with a bolster under the distal humerus.

Position the C-arm parallel to the operating table.

For AP view extend the elbow.

For lateral view rotate the C-arm, not the forearm.

With an assistant holding the arm, disinfect the entire arm down to the fingertips.

Drape the hand in a glove or leave it free.

Drape the arm up to the shoulder.

The optimal position of the surgeon is perpendicular to the operating table in front of the elbow.

The position of the screen should allow a direct view for the surgeon.

The position of operating room personnel should permit ergonomic assistance.