Jackknife Position

What Is It, Uses, and More

Author: Ashley Mauldin, MSN, ARPN, FNP-BC, CNE

Editor: Alyssa Haag

Editor: Emily Miao, PharmD

Editor: Kelsey LaFayette, DNP

Illustrator: Jessica Reynolds, MS

Copyeditor: David G. Walker

Modified: Feb 01, 2024

What is the jackknife position?

The jackknife position, also known as the Kraske position, is a variation of the prone position. It involves positioning an individual on their stomach (i.e., prone) with hips flexed at a 90-degree angle and their head and legs lower than their hips. This positioning can be beneficial during certain surgical procedures involving the anorectal area and spine by improving visualization of the surgical site and minimizing bleeding.

Patient in jackknife position with hip flexed 90 degrees and head lower than hips.

What is the jackknife position used for?

The jackknife position provides visibility of the anorectal area, so it is commonly used during proctologic procedures, including anorectal and colorectal surgeries (e.g., abdominoperineal resection, when parts of the colon, rectum, and anal sphincter are removed). The jackknife position also allows the surgeon to have improved handling of surgical instruments while maintaining ergonomic posture during a procedure where it may be difficult to reach the surgical field. The improved visibility and handling of surgical instruments can help minimize the duration of these surgical procedures. Further, this positioning also uses hip flexion to help decrease intra-abdominal pressure, which can minimize bleeding at the surgical site.

Additionally, this position may be used during certain spinal surgeries (e.g., lumbar discectomy) as it allows for greater accessibility of the spine. A variant of the jackknife position, known as the lateral jackknife position, can also be used. However, it can be associated with a risk of postoperative neurological symptoms like neurapraxia, which is a mild form of peripheral nerve injury that causes weakness and burning in the lower extremities.

There are several factors that can limit the use of the jackknife position and include physical factors, like pregnancy or obesity, and orthopedic factors, like knee or joint problems. The jackknife position can also affect both the cardiovascular and respiratory systems causing a decreased vital capacity and lung compliance related to restricted diaphragmatic movement. Therefore, it may be avoided in individuals with comorbid conditions affecting the heart, blood vessels, and lungs or if there are any concerns for maintaining the patient’s airway.

What are the most important facts to know about the jackknife position?

The jackknife position, also known as the Kraske position, refers to positioning with the individual lying prone with their hips flexed at a 90-degree angle and their head and legs lower than the hips. This positioning provides visibility of the anorectal area and spine during certain surgical procedures and improves handling of surgical instruments and ergonomics for the surgeon.

References

Akinci IO, Tunali U, Kyzy AA, et al. Effects of prone and jackknife positioning on lumbar disc herniation surgery. Journal of Neurosurgical Anesthesiology. 2011;23(4):318-322. doi:10.1097/ana.0b013e31822b4f17

Borodiciene J, Gudaityte J, Macas A. Lithotomy versus jack-knife position on haemodynamic parameters assessed by impedance cardiography during anorectal surgery under low dose spinal anaesthesia: a randomized controlled trial. BMC Anesthesiol. 2015;15:74. doi:10.1186/s12871-015-0055-3

Kumar P, Mishra TS, Sarthak S, Sasmal PK. Lithotomy versus prone position for perianal surgery: a randomized controlled trial. Ann Coloproctol. 2022;38(2):117-123. doi:10.3393/ac.2020.12.16

Kwee MM, Ho YH, Rozen WM. The prone position during surgery and its complications: a systematic review and evidence-based guidelines. Int Surg. 2015;100(2):292-303. doi:10.9738/INTSURG-D-13-00256.1

Molinares DM, Davis TT, Fung DA, et al. Is the lateral jack-knife position responsible for cases of transient neurapraxia? Journal of Neurosurgery: Spine. 2016;24(1):189-196. doi:10.3171/2015.3.SPINE14928

Perry WB, Connaughton JC. Abdominoperineal resection: How is it done and what are the results? Clin Colon Rectal Surg. 2007;20(3):213-220. doi:10.1055/s-2007-984865

Kraske or Jackknife position. The Operating Room Global. https://www.operatingroomissues.org/kraske-or-jackknife-position/