Hip Arthroscopy in Patients With Lower-Extremity Amputations: Patient Positioning and Traction Technique  LCDR Michael P. McCabe, M.D., MC, USN, COL Jeffrey Davila, M.D., MC, USAF  Arthroscopy Techniques  Volume 4, Issue 6, Pages e775-e779 (December 2015) DOI: 10.1016/j.eats.2015.07.026 Copyright © 2016 Terms and Conditions

Fig 1 In this case of bilateral high transfemoral amputations, countertraction is provided by securing the torso and nonsurgical (right) residual limb to the traction table. A hip spica Coban wrap is applied over a layer of egg crate. A well-leg holder, also wrapped in Coban wrap, provides increased friction at this interface. The patient is positioned on the table such that the perineal post can later be placed securely without moving the patient. Arthroscopy Techniques 2015 4, e775-e779DOI: (10.1016/j.eats.2015.07.026) Copyright © 2016 Terms and Conditions

Fig 2 The nonsurgical (right) extremity is secured to the well-leg holder with 3-inch tape over the Coban wrap before the perineal post is placed. Arthroscopy Techniques 2015 4, e775-e779DOI: (10.1016/j.eats.2015.07.026) Copyright © 2016 Terms and Conditions

Fig 3 (A) Preoperative anteroposterior radiograph of surgical left hip and (B) intraoperative anteroposterior fluoroscopic image of a 5-mm centrally threaded skeletal traction pin placed in the subtrochanteric region. An oblique trajectory is selected to allow the pin to traverse the sagittal plane once the leg is internally rotated for hip arthroscopy. The pin is placed sufficiently proximal to the distal end of the femur to minimize fracture risk while providing sufficient bone stock to allow internal fixation should a fracture occur. Arthroscopy Techniques 2015 4, e775-e779DOI: (10.1016/j.eats.2015.07.026) Copyright © 2016 Terms and Conditions

Fig 4 (A) Lateral and (B) frontal views of external fixation construct used for hip distraction. The torso is secured to the surgical table with 3-inch foam tape placed over the spica wrap. Arthroscopy Techniques 2015 4, e775-e779DOI: (10.1016/j.eats.2015.07.026) Copyright © 2016 Terms and Conditions

Fig 5 Traction apparatus. (A) After the 5-mm centrally threaded transosseous pin is placed, a trapezoidal external fixator is constructed with 8-mm bars. (B) The transverse 8-mm rod of the external fixator is fastened to the 90° pin and wire holder, and (C) this apparatus is secured to the traction unit on the fracture table. Arthroscopy Techniques 2015 4, e775-e779DOI: (10.1016/j.eats.2015.07.026) Copyright © 2016 Terms and Conditions