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Rahman, Omar, Robert M. Zbeda, and Anthony A. Romeo. 2021. “The Development of an Orthopaedic Prone Positioning Tool in the COVID-19 Era.” Journal of Orthopaedic Experience & Innovation, May.
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  • Figure 1: Disposable foam head doughnuts provided minimal cushioning and support for patients placed prone for an extended time
  • Figure 2: Patient in the prone position demonstrated to have poor head and neck positioning with the foam head doughnut
  • Figure 3: Prone massage mattresses for pregnant women were too firm for ICU patients and led to the development of facial pressure ulcers
  • Figure 4: Prone Foam, Bone Foam Inc., Corcoran, MN
  • Figure 5: Prototype of the prone positioning tool. There is improved support of the head and neck but not optimized for the patient’s body habitus. The supraorbital, lips, and chin regions are not well-supported and adds pressure on the endotracheal tube.
  • Video 1
  • Figure 6: Place Prone Foam at the level of mid-sternum as a start point. Adjust up or down based on patient’s body habitus and shoulder height.
  • Figure 7: Attach chin and head supports.
  • Figure 8: Adjust head support for optimum placement on patient’s forehead. The patient’s chin should be resting at the chin support and not on the main foam.
  • Figure 9: Confirm that the patient’s shoulders are well-positioned under the foam.
  • Figure 10: In the lateral decubitus position, the assistant managing the chest and shoulders needs to ensure the foam does not become displaced in this position. The assistant should place hands as depicted to guide the foam underneath the patient’s shoulder.
  • Figure 11: If there is not proper support of the foam at the level of the down shoulder in the lateral decubitus position, there will be displacement of the foam.
  • Figure 12: In the prone position, ensure the patient’s eyes and nose are not compressed by the bed or the foam.
  • Figure 13: The foam is compressible to allow for further adjustments and access to the endotracheal tube.
  • Figure 14: Ensure there are no areas of pressure around the nose and lips.
  • Figure 15: The neck and shoulders are positioned in the center of the foam.
  • Figure 16: Neck flexion is in a natural resting position. Adjustments can be made by building up or down the chin support.
  • Figure 17: The cut-out in the foam allows for re-positioning of the endotracheal tube.


Although the COVID-19 pandemic has created hurdles for the practice of orthopedic surgery, it has also provided an opportunity for reflection, innovation, and creative thinking. Orthopedic surgeons utilize clinical knowledge and technical skillsets along with a strong understanding of medical devices to provide effective care for patients. However, these skillsets can also lateralize to other sectors of medicine outside of the surgical theater. From the authors’ experiences at a tertiary orthopedic center, they review the process of repurposing a patient positioning tool in the operating room toward the treatment of intubated COVID-19 patients and discuss the lessons learned.

Accepted: March 10, 2021 EDT