Subbandage pressure assessment in the lower limb during supine positioning of patients in hip arthroplasty when traction is applied: a comparison between single and double layer bandages

Purpose: Patient positioning in orthopedic and trauma surgery requires maximum stability while preserving passive mobility of the operated limb. When traction tables or positioning aids are used, the legs are secured in traction boots. This study evaluated sub-bandage pressure in the lower extremity of a supine-positioned specimen during hip arthroplasty, comparing single- and double-layer bandage systems. Methods: A flexible multilayer and a more rigid single-layer bandage system were compared in mechanical traction tests on a cadaveric specimen. Subbandage pressure was recorded through repetitive measurements at various traction forces, ranging from 80 to 200 N. Results: Due to its rigidity, iFix generated higher pressure near the ankle, providing better stability even at 200 N. In contrast, CO showed higher pressure at the proximal tibia and heel lift at maximum force due to its elasticity. The study found that patient fixation using the tested systems is only justifiable if the tensile force remains below 80 N throughout surgery. Conclusion: Fixation with the tested systems is only advisable if the tensile force remains below 80 N throughout surgery. Short-term increases (e.g., for hip dislocation) are acceptable but should be brief and followed by adequate relief to allow tissue reperfusion. Additional padding is strongly recommended to distribute subbandage pressure at high traction forces.