• Age/Sex: 42-year-old female
• History: Sustained trauma from a road traffic accident
• Comorbidities: None reported
• Condition: Complex radial head fracture requiring excision or fixation

• Mechanism of injury:
• Time and type of accident
• Presence of associated injuries such as head trauma, loss of consciousness, cervical or back pain
• Upper limb symptoms:
• Numbness, paresthesia, or motor weakness
• Pain management:
• Current analgesic medications used
• Pregnancy status:
• Mandatory screening in women of reproductive age
• Past anesthetic history:
• Previous adverse reactions to anesthesia or difficulties with airway management
• Bleeding history:
• Any known bleeding disorders or use of anticoagulants
• Polytrauma assessment:
• Screening for other injuries commonly associated with road traffic accidents

Reference:

American Society of Anesthesiologists. Practice advisory for preanesthesia evaluation: an updated report by the American Society of Anesthesiologists Task Force on Preanesthesia Evaluation. Anesthesiology. 2012;116(3):522-538. doi:10.1097/ALN.0b013e31823c1067

• Laboratory: Complete blood count, renal and liver function tests, electrolytes, coagulation profile
• Urine: Urine pregnancy test
• Cardiac: Electrocardiogram (recommended for age >40)
• Imaging:
• X-ray/CT scan of elbow and forearm
• Chest X-ray or CT if blunt chest injury suspected
• Cervical spine screening where indicated

Reference:

American Society of Anesthesiologists. Practice advisory for preanesthesia evaluation: an updated report by the American Society of Anesthesiologists Task Force on Preanesthesia Evaluation. Anesthesiology. 2012;116(3):522-538. doi:10.1097/ALN.0b013e31823c1067

• Primary technique: General anesthesia as per surgical request
• Regional anesthesia (brachial plexus block): Avoided because:
• Postoperative neurologic evaluation is required to detect surgical nerve injury
• Regional block may mask early signs of compartment syndrome
• Complex surgical dissection expected in close proximity to neural structures

Reference:

American Society of Anesthesiologists. Practice advisory for preanesthesia evaluation. Anesthesiology. 2012;116(3):522-538.

• Supine with the operated arm supported across the chest using a padded bolster or arm board
• Key considerations:
• Neutral shoulder alignment; avoid excessive abduction or stretch
• Adequate padding under the elbow, wrist, and hand
• Secure all lines to ensure continuous airway access and monitor visibility
• Avoid chest compression that could impair ventilation

Reference:

American Society of Anesthesiologists Task Force on Prevention of Perioperative Peripheral Neuropathies. Practice advisory. Anesthesiology. 2018;128(4):657-668. doi:10.1097/ALN.0000000000002025

• Minimize exposure with pulse mode, beam collimation, and reduced fluoroscopy time
• Staff protection with lead aprons and thyroid...