Radiolucent Triangle as a Positioning Tool to Simplify Prone Ankle Fracture Surgery

Prone positioning affords significant benefits for the fixation of trimalleolar ankle fractures and has been the long-time standard for treatment of these injuries. However, 2 primary disadvantages hamper its utility. First, access to the medial ankle is impeded by the contralateral limb and inability to rotate the operative leg to the extent that is possible in other positions. Second, lateral fluoroscopic imaging of the ankle can be cumbersome and often necessitates physically elevating the ankle for a radiograph then placing it back on the operative table. We describe a simple and cost-conscious technique for overcoming these obstacles of prone positioning in ankle fracture surgery. Judicious placement of a radiolucent triangle under the nonoperative leg in the prone position allows for unobstructed access to the medial ankle in conjunction with simplified lateral fluoroscopic imaging. An alternative technique is to place the radiolucent triangle under the operative leg with the bed in reverse Trendelenberg. Surgeons should consider adding these positioning techniques to their operative armamentarium for usage in appropriate cases.

Levels of Evidence: Level V