Supine position (with traction)

(Figure 58)

• Supine position on an orthopaedic traction table, with leg extension supports replacing the conventional foot end of the table (see Figure 9)

• Place a well-padded perineal post into the appropriate hole in the table for Ncounter-traction. The correct hole is usually to the same side as the leg to be operated on. Inserting the post may require abducting the leg or even lifting the patient up the table temporarily

• In conjunction with the anaesthetist looking after the head and neck of the patient, lift the patient down against the perineal post, such that traction will be applied against the ipsilateral pubic rami (not against the external genitalia)

• The ipsilateral arm should be secured across the patient's chest

• Move each leg into position and secure it to the traction attachment. The configuration of the traction attachment will vary according to the desired method of applying traction (see below)

• Remove each leg extension support

• Adjust the position of the leg to be operated on and apply traction as required. As a precaution, support the leg with your hand as traction is applied

• Check that the image intensifier can image the entire surgical area (posteroanterior and lateral views) and check the reduction of any fracture.