Use of a Pneumatic Limb Positioner for Invasive Skeletal Traction in Posterior Hindfoot Arthroscopy Bryan G. Vopat, M.D., Craig R. Lareau, M.D., Rohit B. Sangal, B.A., Amanda J. Fantry, M.D., Brad D. Blankenhorn, M.D. Arthroscopy Techniques Volume 4, Issue 5, Pages e417-e422 (October 2015) DOI: 10.1016/j.eats.2015.03.020 Copyright © 2015 Arthroscopy Association of North America Terms and Conditions
Fig 1 The patient is positioned prone with the distal third of the lower leg below the end of the table in the neutral position. A pneumatic Spider Limb Positioner is attached to the most distal portion of the bed with the contralateral limb secured to a padded post using an elastic wrap with the knee in flexion. Arthroscopy Techniques 2015 4, e417-e422DOI: (10.1016/j.eats.2015.03.020) Copyright © 2015 Arthroscopy Association of North America Terms and Conditions
Fig 2 A miniature C-arm is brought in to ensure that adequate fluoroscopy can be obtained before the patient undergoes sterile preparation. The image intensifier is on the medial aspect of the ankle. The mini C-arm allows for safe portal and instrument placement throughout the case. Arthroscopy Techniques 2015 4, e417-e422DOI: (10.1016/j.eats.2015.03.020) Copyright © 2015 Arthroscopy Association of North America Terms and Conditions
Fig 3 The patient is sterilely draped with an extremity drape. The pneumatic Spider Limb Positioner is left free. Arthroscopy Techniques 2015 4, e417-e422DOI: (10.1016/j.eats.2015.03.020) Copyright © 2015 Arthroscopy Association of North America Terms and Conditions
Fig 4 A standard traction bow is attached to a 2-mm-diameter calcaneal wire that has been placed in the inferior tuberosity in a medial to lateral direction. Arthroscopy Techniques 2015 4, e417-e422DOI: (10.1016/j.eats.2015.03.020) Copyright © 2015 Arthroscopy Association of North America Terms and Conditions
Fig 5 The connector for the noninvasive ankle arthroscopy strap with the strap removed, which will connect to the Tenet Traction Accessory. Arthroscopy Techniques 2015 4, e417-e422DOI: (10.1016/j.eats.2015.03.020) Copyright © 2015 Arthroscopy Association of North America Terms and Conditions
Fig 6 (A) The Tenet Traction Accessory and pneumatic Spider Limb Positioner are sterilely draped; (B) at this point, all of the equipment is sterilely draped. This drape is provided within the pneumatic Spider Limb Positioner kit. Arthroscopy Techniques 2015 4, e417-e422DOI: (10.1016/j.eats.2015.03.020) Copyright © 2015 Arthroscopy Association of North America Terms and Conditions
Fig 7 The connector for the noninvasive ankle arthroscopy strap is attached to the Tenet Traction Accessory. Arthroscopy Techniques 2015 4, e417-e422DOI: (10.1016/j.eats.2015.03.020) Copyright © 2015 Arthroscopy Association of North America Terms and Conditions
Fig 8 (A) The traction accessory is attached to the Dall-Miles cable. (B) The cable is looped through the traction bow, and slack in the cable is minimized before the clasp is crimped. It is important to loop the cable around the arms of the traction connector and crimp over the top of the cable as it extends from the traction bow. This allows the cable to tighten on itself as traction is applied. Arthroscopy Techniques 2015 4, e417-e422DOI: (10.1016/j.eats.2015.03.020) Copyright © 2015 Arthroscopy Association of North America Terms and Conditions
Fig 9 The mini C-arm is sterilely draped and brought into position around the pneumatic limb positioner arm. Arthroscopy Techniques 2015 4, e417-e422DOI: (10.1016/j.eats.2015.03.020) Copyright © 2015 Arthroscopy Association of North America Terms and Conditions
Fig 10 (A) Sagittal computed tomography, (B) axial computed tomography, and (C) sagittal magnetic resonance imaging scans showing a large posteromedial osteochondritis dissecans lesion. Arthroscopy Techniques 2015 4, e417-e422DOI: (10.1016/j.eats.2015.03.020) Copyright © 2015 Arthroscopy Association of North America Terms and Conditions
Fig 11 Arthroscopic images of (A) the talar posteromedial osteochondritis dissecans lesion visualized with a camera placed in the posterolateral portal and (B) the osteochondritis dissecans lesion after debridement and microfracture. Arthroscopy Techniques 2015 4, e417-e422DOI: (10.1016/j.eats.2015.03.020) Copyright © 2015 Arthroscopy Association of North America Terms and Conditions