Andrew Howard, Theddy Slongo, Peter Schmittenbecher
The following are essential for successful surgery:
Before treatment discuss the following information with the patient/parents/carers:
Operating room personnel (ORP) need to know and confirm:
The surgeon should ensure that:
Position the patient supine and place the forearm on an arm table.
For small children, it may be necessary to rest the shoulder on the arm table to allow unimpeded imaging.
This may require gentle lateral flexion of the neck and trunk with appropriate padding and attention to pressure areas.
By abducting the shoulder, it is possible for the surgeon and the assistant to sit on either side of the hand table.
For access to more proximal ulnar shaft fractures, it should be possible to flex the elbow over the child’s chest.
To use the image intensifier the arm must be draped to be able to get AP and lateral views.
With an assistant holding the arm, disinfect the entire arm down to the fingertips.
Drape the hand in a glove or leave it free.
Drape the arm above the elbow.
There are two possible positions for the C-arm:
The optimal position of the surgeon is defined by anatomical requirements of the fixation and may need to be changed during surgery.
The position of the limb should allow complete imaging of the radius and/or ulna in the frontal and sagittal planes.
The position of the screen should allow a direct view for the surgeon.
The position of operating room personnel should permit ergonomic assistance.