Positioning Techniques in Surgical Applications - part 9 ppsx

18 251 . Fig. 18.28. Legs positioned on divided CRP leg plates with individu- al adjustment . Fig. 18.29. Fluoroscopy possible through 360° . Fig. 18.30. Legs positioned on single-section CRP module 1150.45 . Fig. 18.31. Legs positioned on CRP operating table 1150.16 . Fig. 18.32. Minimally invasive operation to the tibia with image intensifier in anteroposterior position . Fig. 18.33. Lateral fluoroscopy of the tibia with left leg lowered 18.4 · Lower leg Chapter 18 · Lower extremities252 18 18.5 Foot 18.5.1 Supine position . Figs. 18.34–18.39. Indications Ventral, anterolateral, medial and posteromedial access to the ankle joint, access to the inner malleolus and outer malleolus, lateral and medial access to the talocalcaneonavicular, front, medial and plantar access to the middle foot and to the toes for fractures, posttraumatic, congenital and acquired misalignment, arthrosis, synovitis, osteochondral lesions, soft tissue lesions and tumours. Preparations 4 Arm positioning devices 4 Wedge cushion, body support 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 Normal 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 both arms on the arm positioning device in abduction position 4 Apply the neutral electrode and connect to the HF surgery device 4 Connect the compressed air supply to the tourniquet 4 Arrange absorbent drapes or self-adhesive covers for preoperative skin disinfection 4 Position the operating lights 4 Patient warming system . Fig. 18.34. Legs positioned on divided CRP leg plates with individual adjustment 18 253 . Fig. 18.36. Divided leg plates with individual adjustment . Fig. 18.35. Legs positioned on divided leg plates with use of the image intensifier . Fig. 18.37. Optimum scanning possibility with lateral ray path due to lowered leg plate . Fig. 18.38. Body support with wedge cushion padding under the pelvis on the other side . Fig. 18.39. Preoperative skin disinfection and additional moisture protection during the operation 18.5 · Foot Chapter 18 · Lower extremities254 18 18.5.2 Lateral position . Figs. 18.40–18.43. Indications Access to the fibula and Achilles tendon, lateral access to the calcaneus and talocalcaneonavicular, medial and posteromedial access to the calcaneus and talocalcaneonavicular for fractures, posttraumatic, congenital and acquired misalignment, arthrosis, synovitis, osteochondral lesions, tumours and soft tissue lesions. Preparations 4 Arm positioning devices 4 Gel ring, gel cushion, Goepel leg holder, lateral supports, radial adjusting clamps, padded cushions (normal and flat) and wedge cushions or tunnel cushions, body belts 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 Normal 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 Fit the radial adjusting clamp to the side rail of the head plate, position the Goepel leg holder and place a gel mat on the operating table 4 Spread out the arm on the side not being operated 4 Move the patient onto the healthy side 4 Move the lower arm forwards so that the weight of the upper body does not lie directly on the shoulder 4 Fit the radial adjusting clamps to the side rails of the back plate and posi- tion the body supports on the level of the coccyx and symphysis 4 1st possibility: position the legs with the padded cushions (normal and flat) and possibly wedge cushions 4 Fix the lower leg and the positioning aids with the body belts 4 2nd possibility: position the legs with the tunnel cushion 4 Apply the neutral electrode and connect to the HF surgery device 4 Connect the compressed air supply to the tourniquet 4 Arrange absorbent drapes or self-adhesive covers for preoperative skin disinfection 4 Position the operating lights 4 Patient warming system 18 255 . Fig. 18.40. Legs positioned on single- section CRP module 1150.45 with padded cushion . Fig. 18.43. Stable positioning of the foot and optimum access for the surgeon with use of the image intensifier from the opposite side in both levels . Fig. 18.42. Lateral positioning on CRP operating table 1150.16 with CRP accessory adapter and lateral positioning cushion for anatomic positioning of the lower arm . Fig. 18.41. Legs positioned on divided CRP leg plates with tunnel cushion 18.5 · Foot Chapter 18 · Lower extremities256 18 18.5.3 Prone position . Figs. 18.44, 18.45. Indications Posterolateral access to the talocalcaneonavicular and concealed osteosyn- thesis in the calcaneal part of the foot. 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 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 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 4 Connect the compressed air supply to the tourniquet 4 Arrange self-adhesive covers for preoperative skin disinfection 4 Position the operating lights 4 Patient warming system Standard operating table position 1, position 2 or universal operating Normal positioning of the operating table in the theatre Apply the neutral electrode and connect to the HF surgery device 18 257 . Fig. 18.44. Prone position on universal operating table 1150.30 with arms positioned in maximum 90° abduction . Fig. 18.45. Use of the image intensifier in anteroposterior position. C-arm with colour- ed handles for better communication bet- ween surgeon and operator 18.5 · Foot 19 19 Positioning on the extension table 19.1 Extension table proximal femur – 260 19.1.1 Supine position – 260 19.2 Extension table thigh – 262 19.2.1 Supine position – 262 19.3 Extension table lower leg – 264 19.3.1 Supine position – 264 Chapter 19 · Positioning on the extension table260 19 19.1 Extension table proximal femur 19.1.1 Supine position . Figs. 19.1–19.5. Indications of extension and fluoroscopy in two levels, and displacement osteotomy of the proximal femur. Preparations 4 Arm positioning devices 4 4 Shaving in the area of the incision and preoperative skin cleansing 4 Positioning 4 Universal operating table for traumatology and orthopaedic procedures (extension table) 4 Anaesthetic preparation and induction in supine position with 2 adapted arm positioning devices 4 If necessary, diagonal 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 4 4 Insert the countertraction post on the side being treated 4 Insert the long telescopic bar in the extension bar on the side not being operated 4 Insert the short telescopic bar in the extension bar on the side being ope- rated 4 Fit the foot plate adapter 4 Fit the screw tension device 4 Fit the rotating and tilting clamp to the screw tension device 4 Place a double wedge cushion on the operating table 4 Fit the arm positioning device to the side rails of the lower back plate on the side not being operated 4 Fit the anaesthesia screen with a radial adjusting clamp to the side rail of the upper back plate on the left-hand side 4 Fit the anaesthesia screen extensions and possibly suspend 2 arm straps 4 Position the foot plates before transferring the patient 4 Transfer the patient from the induction table to the prepared operating table in supine position 4 Fit the positioned foot plates to the screw tension device and foot plate adapter, constantly pulling the legs at the rotating and tilting clamp 4 Position the arms 4 Reposition the fracture using the image intensifier and position the legs 4 Check all screwed and clamped connections 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 Risks 4 Secondary dislocation 4 Osteosynthesis of the proximal femur entailing reposition with the possibility Extension table accessories G-arm, alternatively 1 or 2 C-arms Longitudinal adjustment of the operating table towards the feet (1150.20) Swivel the extension bars in a V-shape towards the feet Nerve injuries (n. pudendus) [...]... rotating and tilting clamp with padded, fixed foot 19 262 Chapter 19 · Positioning on the extension table 19. 2 Extension table thigh 19. 2.1 Supine position Figs 19. 6– 19. 8 Indications Medullary nailing, intramedullary reaming Preparations 4 Two arm positioning devices 4 Extension table accessories 4 Shaving in the area of the incision and preoperative skin cleansing Positioning 4 Universal operating... Operating table 1150.20 with fitted foot plate, healthy leg is positioned downwards on a special support 19 264 Chapter 19 · Positioning on the extension table 19. 3 Extension table lower leg 19. 3.1 Supine position Figs 19. 9– 19. 11 Indications Medullary nailing, intramedullary reaming Preparations 4 Two arm positioning devices 4 Shaving in the area of the incision and preoperative skin cleansing Positioning. .. belts 4 Gallows for arm extension 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 Crosswise positioning of the operating table in the theatre 4 When positioning the patient, take appropriate measures... Shaving in the area of the incision and preoperative skin cleansing Positioning 4 Beach-chair operating table position 2 or universal operating table with shoulder 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... incision and preoperative skin cleansing G-arm, alternatively 1 or 2 C-arms Positioning 4 Universal operating table for traumatology and orthopaedic procedures (extension table) 4 Anaesthetic preparation and induction in supine position with 2 adapted arm positioning devices 4 If necessary, diagonal positioning of the operating table in the theatre 4 When positioning the patient, take appropriate measures... atresia) 4 Warming mat, warming lamp 4 Arm positioning device only for older children Positioning 4 4 4 4 4 4 4 4 4 4 Children’s operating table in the neutral position Connect the warming mat and lamp, affix the temperature sensor Prepare and induce the anaesthetic in the supine position Transfer to the prone position in the operating theatre, for older children using a second operating table (see... preparation and induction in supine position with 2 adapted arm positioning devices 4 If necessary, diagonal 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 Longitudinal adjustment of the operating table towards the feet (1150.20) 4 Swivel the extension bars in a V-shape towards... 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 19 Risks 4 Iatrogenic damage caused by inserting the Steinmann nail 4 Pressure injuries 4 Compartment syndrome from overdistraction 265 19. 3 · Extension table lower leg Fig 19. 9 Operating table 1150.20 with tibia device and fitted Kirschner... ligament injuries, meniscus lesions, cartilage damage, arthrosis, floating cartilage, synovitis, fractures and osteochondrosis dissecans Preparations 4 Arm positioning devices 4 Tourniquet, cotton wool padding, elastic bandages, perforated rubber sheet knee holder, special positioning cushion 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 induction in the supine position, padding under the shoulders 4 Normal 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 both arms on the arm positioning devices in 45° abduction . lower leg 19. 3.1 Supine position . Figs. 19. 9– 19. 11. Indications Preparations 4 Two arm positioning devices 4 Shaving in the area of the incision and preoperative skin cleansing Positioning 4 Universal. Fig. 19. 4. Preoperative skin disinfection 19. 1 · Extension table proximal femur Chapter 19 · Positioning on the extension table262 19 19. 2 Extension table thigh 19. 2.1 Supine position . Figs. 19. 6– 19. 8. Indications Preparations 4. position . Figs. 19. 6– 19. 8. Indications Preparations 4 Two arm positioning devices 4 4 Shaving in the area of the incision and preoperative skin cleansing Positioning 4 Universal operating table for traumatology