Fixation

Michael L. Brennan

Sterile Instruments/Equipment

• Large/medium external fixation system
  
• Open compressor/distractor device
  
• 4.0-mm partially threaded pins for forefoot fixation
  
• Towel bolsters/bumps
  
• Dental pick
  
• Traingular bolster

Positioning

• Supine on a radiolucent cantilever-type table.
  
• Bring patient to the radiolucent (foot) end of the table.
  
• Place small bolster/bump under the ipsilateral hemipelvis and torso.
  
• Elevate the leg on soft ramp cushion to facilitate lateral imaging.
  
• Triangular bolster improves imaging of foot (Fig. 29-1).

Figure 29-1. Foot position for external fixation. Note radiolucent triangle flexing hip and knee to facilitate obtaining true AP and oblique views of foot, when C-arm is in vertical position.

• With the knee fully flexed, five folded towels under the forefoot allow correct radiographic view of Lisfranc joint with AP fluoroscopy, if necessary.

Surgical Approach

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