"Jahwari's Position" - A Novel Operating Room Setup for Antegrade Humeral Nailing: Surgical Technique and Initial Experience.

Introduction: Ante Grade Humeral Nailing (AGHN) with traditional positioning causes crowding at the patient's head end, cramming for the surgeon and anaesthetist, scarcity of space available for the scrub nurse and X-ray technician, and neurovascular risks while performing distal interlocking. Minimal literature is available regarding the optimal position and set up in the operating theatre (OT). The primary objective was to describe, how effective novel Jahwari's position is by assessing the ergonomics for OT personnel, OT time, and radiation exposure. A secondary objective was to evaluate the safety of inserting distal interlocking screws. Surgical Technique: The head of the patient is placed away from the anaesthetist and their equipment, which were placed at the foot end of the patient. The patients were connected to the anaesthesia machine with a long airway extension, which was anchored to the table. The C arm machine was brought from the contralateral side and did not have to be moved. The scrub nurse and the surgeon were placed at the head end of the patient. Pregnant patients, those aged <18 years, and those with open fractures were excluded from our study. A single consultant operated on all cases for standardization. OT time and radiation exposure were monitored. Conclusions: Inspired by our use of this position for cervical spine patients for more than a decade, Jahwari's position and setup were innovated. This setup gives ample room for the anaesthetist at the foot end. The surgeon and assistants are free from cramming at the head end. Complementarily, it provides ample space for the X-ray technician and scrubs nurse.