New technique of imaging and treatment of pediatric supracondylar humeral fracture without moving the injured limb

The management of closed, displaced supracondylar fracture of humerus in children can be divided into 3 stages. In stage 1 closed reduction is achieved whose acceptability is confirmed, on table, in stage 2 using an image intensifier. This reduction is maintained in stage 3 by immobilization in slab/cast or by percutaneous Kirschner wire fixation. Although enough literature for proper technique in stage 1 and stage 3 are available, there are certain practical problems encountered in the equally important stage 2, which needs a closer look. Most of the C-arm compatible tables have their metallic base toward the head end of the table with metal bar on the sides for additional attachments. These interfere with the rotation of the image intensifier and also with the quality of the image obtained. As a result, to obtain lateral image many surgeons rotate the fractured upper limb instead of the C arm. This practice is unacceptable, as rotating the fractured limb cannot only add to the injury but it can also cause loss of reduction. Similarly, many surgeons strongly condemn using the image intensifier as an operating table. We are proposing a new surgeon and anesthetist friendly method of positioning the patient in which both anteroposterior and lateral views can be obtained without moving the fractured upper limb. In addition, if required the surgeon can proceed to open reduction without the need to reposition or re drape the patient.