A sterile triangle positional assist for posterior approaches to the acetabulum in the lateral position: a technical trick.

Abstract

Acetabular fractures are complex injuries that often pose unique challenges to orthopedic surgeons during approach, reduction, and fixation. Many of these injuries require posterior approaches that can be performed in the prone or lateral position. It is important during these posterior approaches, regardless of position, to keep the operative lower extremity in a position of safety. The limb should be positioned with the hip extended, internally rotated, and the knee flexed to relax tension on the sciatic nerve and avoid iatrogenic injury. In the lateral position a surgical assistant usually maintains the limb in this position. This article presents a simple technique of using a sterile triangle positional assist, rather than an assistant, to maintain this limb position. Over 5 years, one surgeon utilized this technique intraoperatively in 23 patients undergoing a posterior approach for fixation of acetabular fractures in the lateral position and had no iatrogenic sciatic nerve injuries. The sterile triangle positional assist represents a simple and reproducible technique for safe limb positioning during posterior approaches to the acetabulum that does not require a surgical assistant.