7 4 S U P P L E M E N T T O O U T P A T I E N T S U R G E R Y M A G A Z I N E A U G U S T 2 0 1 7
Plenty of help available
Positioning patients for extremity procedures is more difficult than it is for cen-
tral core surgery, says Dr. Archdeacon. The level of difficulty ramps up if, for
example, he's operating on the left shoulder, but needs to stand on the right side
of the patient to access the correct spot in the joint.
"Access to the shoulder is particularly critical and often challenging," says Dr.
Archdeacon. "Patients must be positioned to provide three-quarter access to all
areas of the joint."
He touts the use of foam, radiolucent positioning aids that increase patient
comfort and are designed to position extremities for specific procedures. For
example, he uses one pad specifically designed to protect and place patients in
the lateral position for improved access to the shoulder and hip.
Dr. Archdeacon says adjunct positioning aids have evolved significantly in
recent years — they nearly match the performance of custom positioners. The
latest arm boards, leg holders, shoulder positioners and "beach chair" attach-
ments feature low profiles and can be flipped between left and right configura-
tions to turn conventional tables into surfaces suitable for complex joint pro-
cedures. Some newer traction devices attach to surgical tables and let sur-
geons position arms or legs without help from an assistant. Budget-conscious
surgery centers interested in adding same-day joints can invest in specially
designed table attachments that let surgeons perform the muscle-sparing ante-
rior approach to the hip.
Clear expectations
Dr. Tucker has been called "meticulous" about the way he positions patients for
surgery and wears the label with pride. "I'm the captain of the ship, so I'm
responsible for making sure my patients are properly positioned," he says in a
matter-of-fact sort of way, without a trace of chest-pounding bravado.
Dr. Archdeacon agrees that the responsibility falls on surgeons to clearly
communicate with the surgical team precisely how patients need to be posi-
