Pol Rommens, Peter Trafton, Martin Jaeger
Chris Colton, Steve Krikler
Posterior plating and retrograde nailing may be performed in the prone position. This position may also be used for exploration of the radial nerve.
Operating room personnel (ORP) need to know and confirm:
Due to patient position and working area, general anesthesia with or without additional nerve block provides adequate comfort for the patient and the operating team.
Place the upper arm on a radiolucent arm table or arm rest, with the elbow flexed to 90º.
Support the thorax before fixation of the patient’s head.
Take care to position the head and fix the endotracheal tube securely.
Introduce the image intensifier from the top of the OR table.
The entire humerus including humeral head and elbow must be visible in two planes with the image intensifier. This works best if the C-arm comes from the top of the table parallel to the table.
Disinfect the exposed area from the neck to the hand including the axilla with the appropriate antiseptic.
Drape in such a way as to leave the humeral head area, upper arm, and elbow joint exposed. The hand and forearm should be draped separately with a stockinette well fixed to the forearm.
Drape the image intensifier.
The anesthetist and anesthetic equipment should be situated at the side of the patient.
The surgeon and assistant stand on the side of the injury.
The ORP stands between (behind) the surgeons.
Place the image intensifier display screen in full view of the surgical team and the radiographer.