Hang them high: a hands-free technique for limb-holding during surgical preparation

We describe the use of a suspension system to provide hands-free elevation and traction of lower limbs during preoperative skin preparation. The technique is particularly useful for fractured limbs that are often both awkward to elevate by hand and present a physical challenge to lift and hold. Furthermore, limb-lifting and holding has been identified by the National Association of Orthopaedic Nurses as a commonly performed task associated with high risk of work-related musculoskeletal disorders. The National Association of Orthopaedic Nurses Task Force has recommended the use of assisted lifting and holding devices if the task of limb elevation and or holding exceeds its recommended limits. The principal determinants of these limits are the weight of the leg, the height it is elevated above the chest, and the time for which it is held. The maximal weight recommended for a two hand lift is 35 pounds, which is often less than the weight of a patient's leg whose total body weight is over 190 pounds. The maximal limit is below 35 pounds for lifts above chest height and for holds over 1 minute. Because the average size and weight of American citizens is increasing, so has the need for devices to assist with lifting and holding in the operating room. This technique also can improve operating room efficiency because a member of the operating team is not engaged in holding the limb during the skin preparation and draping. The limb is also held reliably with constant in-line traction by this technique. This reduces the chance for accidental decontamination of the skin or further movement of the fracture and potential secondary soft tissue damage if the limb holder loses or changes their grip.