To the Editor:—
When positioning a patient on the fracture table for open reduction/internal fixation of a femoral neck fracture, it is commonly necessary to secure the arms over the chest in a crossed fashion to avoid contact with the fluoroscope. Most hip fracture patients are elderly, and are at risk for skin abrasions if tape is used for this purpose. Wrapping sheets around the patient to secure the arms can prevent access to the peripheral intravenous site, and may not adequately restrain the arms during manipulation of the lower extremities by the surgical team.
We have successfully been using a soft foam donut-style headrest to gently but securely restrain the patient's arms across the chest. This method is well tolerated by a conscious patient with a regional block. It allows unobstructed access to hands and arms for peripheral venous or arterial line manipulation, and permits the use of a standard safety belt to hold the patient on the table.
To use a foam doughnut headrest for this purpose, first insert the patient's left arm into the hole and advance the headrest above the elbow until it is around the distal third of the humerus. Position that arm across the chest with the left hand lying over the right biceps area. Then cross the right forearm over the left forearm so the left wrist rests in the antecubital area of the right arm, and insert the right hand and wrist into the hole. The circular insert from the foam headrest may then be placed between the arms to pad one from the other. Of course, right and left arm positions may be switched as dictated by line placement or convenience. The final arrangement is shown in figure 1.