Reinventing the floppy lateral position for dual approaches in COVID-19 times

Dual approaches are often used in complex lower limb fracture surgery. A well-accepted strategy is to definitively reduce and fix one part of the fracture (commonly the posterior articular surface in a pilon or tibial plateau fracture) with the patient in one position, and then reposition the patient to access the other side of the fracture. The change of position prolongs the anaesthetic and surgical time. In the context of the coronavirus 2019 (COVID-19) pandemic, it also causes concern with donning and doffing. We describe a mobile floppy lateral position that enables dual approaches to the ankle, distal tibia, tibial plateau, and the acetabulum without having to change the patient positioning. The patient is positioned lateral on a radiolucent table, usually with the affected side on top. No supports are placed around the pelvis, allowing the patient's pelvis to flop forwards or backwards. Two supports are placed around the chest and a strap is placed to secure the patient to the table if deemed necessary. The initial surgical procedure can be performed by flopping the patient's pelvis forwards, allowing access to the posterior leg, knee or hip. Once satisfactory fixation is achieved, the pelvis is rolled backwards to allow access to the anterior aspect of the fracture.