Ortho Advice


Hanging Upside Down

When calling an orthopedic specialist regarding a severe leg fracture, the advice I was given was to admit the patient and to “elevate the hell out of it.”

I didn’t think to ask at the time, but exactly how should we accomplish that task?

I can see a patient swinging back and forth in their room, dangling from the ceiling by the affected leg.

“Hey doc! How’s this?”


  1. I have enough metal in my right leg that I have joked about being able to do this from one of those magnetic scrapyard cranes.

  2. One can “Gatch” the foot of the hospital bed. There is typically an arch of metal that can be raised into notches underneath the foot of the mattress, much like a typical poolside loungechair back. Unlike the electrical control one can generally get the foot a bit higher, but one could also use the powered control and there is usually a way to lock it to stop the patient or nurse froma inadvertently defeating it. (A Gatch Bed can similarly be adjusted to raise the head of the bed). In addition one can create a large bolster from blankets and pillows. The idea is to get the foot a bit higher than the knee, and the knee higher than the heart. If the fracture is properly splinted that will also help. Beware of constriction or pressure from the splint. In “the old days” we used traction more, and there are still some indications (usually hanging from a frame but not from the ceiling). Most orthopaedic trauma specialists talk about damage control now. It is often better to wait for swelling to substantially resolve before definitive surgical fixation, and sometimes that means initial immobilization with external fixator if a splint is not enough, typically for a tibial plafond fracture for example. Those with lots of soft tissue injury are at increased risk for DVT, so we often consider anticoagulation (tibia plateau or plafond fractures, high energy comminuted fractures).

    Steve Zeitzew, Orthopaedic Surgeon

    • @Steve Zeitzew: Were you spying on me during my two weeks in the hospital and five surgical procedures? 🙂

      Everything you mentioned except for the Gatching (cool name, BTW) was done to me.

  3. Since ER beds suck, a good way to elevate the Hell out of a leg is to put it in the sling on an EZ Lift or equivalent and just raise it up! Not like ERs use lift equipment for anything else! It works!

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