Archive Orthopedic Surgery 2016

Orthopedic Positioning Pointers in Photos

When procedures call for you to suspend limbs, articulate joints and hyperextend necks, injuries are just waiting to happen.

Kris Lindeen, BSN, RN


From pinched skin and pinched nerves to pulled muscles and pressure ulcers, we can easily hurt our orthopedic patients just by the way we position them for surgery. Good positioning in orthopedics should maximize the surgeon's ability to see and access the surgical site and minimize pain and injury to patients that we twist like a pretzel on the OR table. With a huge assist from Pamela Bevelhymer, RN, BSN, my colleague here at the Northwest Michigan Surgery Center and the staff photographer for Outpatient Surgery Magazine, we proudly present 8 pictures that portray proper patient positioning. OSM

elbow or shoulder

SUSPENDED ARM For an elbow or shoulder arthroscopy, patients have to lie with their arm extended over their head for extended periods of time for prepping and surgery. Rather than having a staff member hold the patient's arm, securely suspend it by hanging it from a gauze roll tied off on a weighted IV pole.

prone position

PRONE POSITION In the prone position, you must consider the patient's body from head to toe. You want the patient lying face down in the prone holder, but slightly elevated (or tilted to the left or right) so that the anesthetist can maintain the airway. To keep patients well oxygenated, make sure the chest is well supported so they can get good ventilation if under general anesthesia or they can breathe normally if under monitored sedation. Gel chest rolls or rolled blankets offer good chest support. You should also pad the knees. Finally, take care not to squish women's breasts or compress men's genitals.

knee arthroscopy

LEG HOLDER A surgical assistant places the patient into a leg holder for a knee arthroscopy. Note that the tourniquet is high up on the thigh so it doesn't pinch the patient's skin. The stockinette under the tourniquet also helps protect the skin. To decrease the risk of injury, a staff member holds the leg while the assistant positions it in the leg holder.

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