Positioning Techniques in Surgical Applications - part 8 pot

Chapter 17 · Upper extremities218 17 17.1 Shoulder 17.1.1 Supine position . Figs. 17.1, 17.2. Indications Ventral, axillary, transdeltoid access to the shoulder joint, access to the clavicle and to the acromioclavicular joint for fractures, pseudarthrosis, posttraumatic misalignment, luxation, instability, tumours, inflammation and rupture of the biceps tendon. Preparations 4 Arm positioning devices 4 Remove Gilchrist bandage 4 Gel ring 4 Shaving in the area of the incision and preoperative skin cleansing Positioning 4 Standard operating table position 1, position 2 or universal operating table with X-ray protection, clavicle remains available for scanning 4 Anaesthetic preparation and induction in supine position with 2 adapted arm positioning devices 4 Crosswise positioning of the operating table in the theatre 4 When positioning the patient, take appropriate measures to prevent decubitus at areas which are subjected to pressure 4 Tilt the operating table in the Trendelenburg position, raise the back plate by 20–30°, lower the leg plates and the head section by hand 4 Position the head on a gel ring, possibly slightly turned to the other side and reclined 4 Position the infusion arm on an arm positioning device 4 Pad the shoulder with a positioning aid, thus raising the operating site or joint being operated 4 Cover the arm on the side being operated while leaving it free to move and position it at the body with arm protection or place it on the arm posi- tioning device 4 Apply the neutral electrode and connect to the HF surgery device 4 Arrange self-adhesive covers for preoperative skin disinfection 4 Position the operating lights 4 Patient warming system 17 219 . Fig. 17.1. Supine position with arms posi- tioned at the body (arm protection with padding) . Fig. 17.2. Supine position on special shoul- der plate with the advantage of scanning and the head on a one-piece horseshoe-shaped headrest 17.1 · Shoulder Chapter 17 · Upper extremities220 17 17.1.2 Beach-chair position . Figs. 17.3–17.7. Indications Ventral, transdeltoid access to the shoulder joint, access to the clavicle and to the acromioclavicular joint for fractures, pseudarthrosis, posttraumatic mis- alignment, luxation, instability, tumours, inflammation, rupture of the biceps tendon, arthrosis, impingement syndrome and rotator cuff lesions. Preparations 4 Arm positioning devices 4 Remove Gilchrist bandage 4 Gel ring 4 Shaving in the area of the incision and preoperative skin cleansing Positioning 4 Beach-chair (BC) operating table position 2 or universal operating table with special back plate 4 Anaesthetic preparation and induction in supine position with 2 adapted arm positioning devices 4 Crosswise positioning of the operating table in the theatre 4 When positioning the patient, take appropriate measures to prevent decubitus at areas which are subjected to pressure 4 The patient’s shoulders end at the upper edge of the operating table 4 Bring the operating table gradually to the half-sitting (beach-chair) position 4 Raise the back plate and alternately lower the head of the complete opera- ting table until the final position is reached 4 Change the Bowden cable over and lower the legs to the horizontal po sition (system 1120) 4 Position the head on a gel ring and fix with transparent plaster right across the forehead or use a head support for shoulder operation (U-shaped helmet) 4 Position the infusion arm on an arm positioning device 4 Cover the arm on the side being operated while leaving it free to move and position it at the body with arm protection or place it on the arm positio- ning device 4 Apply the neutral electrode and connect to the HF surgery device 4 Fit the thorax support to the side rail of the shoulder plate 4 Arrange self-adhesive covers for preoperative skin disinfection 4 Position the operating lights 4 Patient warming system Risks 4 Iatrogenic injuries to the eyes and soft tissues (head fixing) when fixed with plaster or foil 4 Secondary dislocation 17 221 . Fig. 17.7. Thorax support . Fig. 17.6. A segment is removed to leave free access to the rear shoulder . Fig. 17.5. The universal operating table with special shoulder plate is adapted to the body . Fig. 17.3. Beach-chair positioning on special shoulder plate with helmet for safe positioning of the head . Fig. 17.4. The thorax support offers additional safety 17.1 · Shoulder Chapter 17 · Upper extremities222 17 17.1.3 Prone position . Figs. 17.8, 17.9. Indications Dorsal and transacromial access to the shoulder joint and access to the scapu- la for luxation, fractures, posttraumatic misalignment, instability, tumours, rotator cuff lesions. Preparations 4 Arm positioning devices 4 Special head positioning cushion for prone position 4 Thorax, pelvic and wedge cushion, padded roll 4 Shaving in the area of the incision and preoperative skin cleansing Positioning 4 Standard operating table position 1, position 2 or universal operating table 4 Anaesthetic preparation and induction in supine position with 2 adapted arm positioning devices 4 Transfer to the prepared operating table in the induction room 4 Position both tables next to each other, with the prepared table lowered 4 Place the patient in prone position on the padded cushion of the prepared operating table and take him into the theatre 4 Crosswise positioning of the operating table in the theatre 4 When positioning the patient, take appropriate measures to prevent decubitus at areas which are subjected to pressure 4 Position the head on the special head positioning cushion 4 Position both arms on the arm positioning devices 4 Apply the neutral electrode and connect to the HF surgery device 4 Arrange self-adhesive covers for preoperative skin disinfection 4 Position the operating lights 4 Patient warming system 17 223 . Fig. 17.8. Prone position with small arm plate/upper arm plate . Fig. 17.9. The distal joint is positioned lower than the proximal joint 17.1 · Shoulder Chapter 17 · Upper extremities224 17 17.2 Upper arm 17.2.1 Supine position . Figs. 17.10–17.13. Indications Extended ventral access to the shoulder joint and ventral, medial and lateral access to the humerus for fractures, pseudarthrosis, posttraumatic misalign- ment, tumours, inflammation, nerve lesions. Preparations 4 Arm positioning devices 4 Remove Gilchrist bandage 4 Shaving in the area of the incision and preoperative skin cleansing Positioning 4 Standard operating table position 1, position 2 or universal operating table with X-ray protection 4 Anaesthetic preparation and induction in supine position with 2 adapted arm positioning devices 4 Crosswise positioning of the operating table in the theatre 4 When positioning the patient, take appropriate measures to prevent decubitus at areas which are subjected to pressure 4 Standard supine position, infusion arm is spread out 4 Remove the arm positioning device and fasten the large arm table to the side rail of the back plate 4 Position the patient near to the edge of the table 4 Apply the neutral electrode and connect to the HF surgery device 4 Arrange self-adhesive covers for preoperative skin disinfection 4 Position the operating lights 4 Patient warming system . Fig. 17.10. Arm positioning on large arm table 17 225 . Fig. 17.11. 360° fluoroscopy possibility . Fig. 17.13. Arms positioned with maximum approx. 50° abduction in pronation position . Fig. 17.12. Arms positioned with maximum 90° abduction in supination position 17.2 · Upper arm Chapter 17 · Upper extremities226 17 17.2.2 Prone position . Figs. 17.14–17.16. Indications Dorsal access to the humerus for fractures, pseudarthrosis, posttraumatic misalignment, tumours, inflammation, nerve lesions. Preparations 4 Arm positioning devices 4 Special head positioning cushion for prone position 4 Thorax, pelvic and wedge cushion, padded roll 4 Small arm rest, X-ray protection, C-arm (poss. G-arm) in the theatre 4 Remove Gilchrist bandage 4 Shaving in the area of the incision and preoperative skin cleansing Positioning 4 Standard operating table position 1, position 2 or universal operating table 4 Anaesthetic preparation and induction in supine position with 2 adapted arm positioning devices 4 Transfer to the prepared operating table in the induction room 4 Position both tables next to each other, with the prepared table lowered 4 Place the patient in prone position on the padded cushion of the prepared operating table and take him into the theatre 4 Crosswise positioning of the operating table in the theatre 4 When positioning the patient, take appropriate measures to prevent decubitus at areas which are subjected to pressure 4 Position the head on the special head positioning cushion 4 Position the infusion arm on the arm positioning device 4 Position the patient near to the edge of the table, until the injured/fractured arm hangs at the elbow over the edge of the small arm rest with the lower arm in a vertical position 4 Apply the neutral electrode and connect to the HF surgery device 4 Arrange self-adhesive covers for preoperative skin disinfection 4 Position the operating lights 4 Patient warming system 17 227 . Fig. 17.14. Prone position with small arm plate/upper arm plate . Fig. 17.15. The distal joint is positioned lower than the proximal joint . Fig. 17.16. Use of the image intensifier on the head side (here in anteropos- terior position) offers optimum scope for swivelling round 17.2 · Upper arm [...]... Fig 17.29 Operation scene 17 18 18 Lower extremities 18. 1 Hips 18. 1.1 18. 1.2 Supine position – 236 Lateral position – 2 38 18. 2 Thigh 18. 2.1 18. 2.2 18. 2.3 Supine position – 240 Modified supine position Lateral position – 244 18. 3 Knee 18. 3.1 18. 3.2 Supine position – 246 Prone position – 2 48 18. 4 Lower leg – 250 18. 4.1 Supine position – 250 18. 5 Foot 18. 5.1 18. 5.2 18. 5.3 Supine position – 252 Lateral position... table Shaving in the area of the incision and preoperative skin cleansing Apply a tourniquet in position Positioning 4 Standard operating table position 1, position 2 or universal operating table with X-ray protection 4 Anaesthetic preparation and induction in supine position with 2 adapted arm positioning devices 4 Crosswise positioning of the operating table in the theatre 4 When positioning the patient,... lateral positioning cushion for anatomic positioning of the lower arm Fig 18. 7 Lateral position on universal operating table with vacuum mat Fig 18. 8 Lateral position on universal operating table with lateral positioning cushion and operating table in flex position for neutral position of the spinal cord 18 240 Chapter 18 · Lower extremities 18. 2 Thigh 18. 2.1 Supine position Figs 18. 9– 18. 13 Indications... tumours Preparations 4 Arm positioning devices 4 Shaving in the area of the incision and preoperative skin cleansing Positioning 4 Standard operating table position 1, position 2 or universal operating table 4 Anaesthetic preparation and induction in supine position with 2 adapted arm positioning devices 4 Normal positioning of the operating table in the theatre 4 When positioning the patient, take appropriate... Preparations 4 Arm positioning devices 4 Shaving in the area of the incision and preoperative skin cleansing 4 Apply a tourniquet in position Positioning 4 Standard operating table position 1, position 2 or universal operating table 4 Anaesthetic preparation and induction in supine position with 2 adapted arm positioning devices 4 Transfer to the prepared operating table in the induction room 4 Position... Fig 18. 17 on p 243) 18 242 Chapter 18 · Lower extremities 18. 2.2 Modified supine position Figs 18. 14– 18. 17 Indications Closed and open osteosynthesis procedures to the femur requiring intraoperative fluoroscopy with a lateral ray path Preparations 4 Arm positioning devices 4 Shaving in the area of the incision and preoperative skin cleansing 4 Anaesthesia screen, Goepel leg holders, radial adjusting... individual adjustment Fig 18. 22 Scanning possible through 360° Fig 18. 23 Legs positioned on single-section CRP module 1150.45 Fig 18. 24 Legs positioned on CRP operating table 1150.16 Fig 18. 25 Foot holder for total replacement of the knee joint 18 2 48 Chapter 18 · Lower extremities 18. 3.2 Prone position Figs 18. 26, 18. 27 Indications Rear access to the knee joint for ligament injuries, tumours, vessel... Chapter 18 · Lower extremities 18. 1 Hips 18. 1.1 Supine position Figs 18. 1– 18. 5 Indications Ventral, anterolateral and lateral access to the hip joint for coxarthrosis, fracture of the neck of the femur, loosening of a hip replacement, necrosis of the head of the hip and tumours Preparations 4 Arm positioning devices 4 Shaving in the area of the incision and preoperative skin cleansing Positioning 4 Standard... the area of the incision and preoperative skin cleansing 4 Apply a tourniquet in position Positioning 4 Standard operating table position 1, position 2 or universal operating table 4 Anaesthetic preparation and induction in supine position with 2 adapted arm positioning devices 4 Normal positioning of the operating table in the theatre 4 When positioning the patient, take appropriate measures to prevent... Masking the extremity for preoperative skin disinfection and additional moisture protection also during the operation Fig 18. 16 Positioning the fractured leg on a leg plate with use of the image intensifier Fig 18. 17 Good covering techniques allow for movement of the extremity 18 244 Chapter 18 · Lower extremities 18. 2.3 Lateral position Figs 18. 18 18. 20 Indications Lateral access to the femur for . abduction in supi- nation position 17.4 · Lower arm and hand 18 18 Lower extremities 18. 1 Hips – 236 18. 1.1 Supine position – 236 18. 1.2 Lateral position – 2 38 18. 2 Thigh – 240 18. 2.1 Supine position. 250 18. 5 Foot – 252 18. 5.1 Supine position – 252 18. 5.2 Lateral position – 254 18. 5.3 Prone position – 256 Chapter 18 · Lower extremities236 18 18. 1 Hips 18. 1.1 Supine position . Figs. 18. 1– 18. 5. Indications Ventral,. Gilchrist bandage 4 Gel ring 4 Shaving in the area of the incision and preoperative skin cleansing Positioning 4 Beach-chair (BC) operating table position 2 or universal operating table with special