Closed intramedullary nailing of the tibia: a better draping technique

Abstract

Draping is an important step in any surgical procedure. Accurate placement of drapes is necessary to prevent any disarrangement during the operative procedure and to avoid contamination of both the surgeon and the surgical field. In closed intramedullary nailing of the tibia the affected limb can be positioned with or without traction. For the application of traction a Steinmann pin is inserted through the calcaneus before positioning the patient on the fracture table. The limb to be operated upon is positioned with the hip flexed to 45 and the knee flexed to 90 with the heel attached to the traction [1]. The affected lower extremity is draped from the distal thigh to the calcaneal traction pin. This can be done in a standard manner. Foundation drapes are employed to drape the leg proximally above the knee covering the bar beneath the distal thigh and distally at the ankle covering the traction pin. These drapes are secured with towel clips. Further, drapes are used to cover the contralateral limb and the rest of the body. The image intensifier arm is covered with a sterile isolation drape. Considerable experience is required in placing these drapes as any disarrangement or suspected contamination would entail the whole procedure having to be repeated. We describe a draping technique that is simpler yet effective. A large isolation drape with Ioban 2 incise film and pouch that is used for the procedures on the femur is used. After positioning, the affected limb is painted with antimicrobial solution and then wiped dry. The incise film portion of the isolation drape is then placed longitudinally over the limb and the isolation drape is unfolded over the upper body, the contralateral limb and the distal portion of the fracture table (Figs. 1, 2). This allows access and movement for the C-arm of the image intensifier under sterile conditions over the affected limb. This surgical drape is impervious to liquid, maintaining a barrier between sterile and non-sterile areas. As Eur J Orthop Surg Traumatol (2002) 12: 58–59 DOI 10.1007/s00590-002-0007-8