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 opposite sides of the hand table.
The elbow may be flexed and held by an assistant. This setup is useful for access to the olecranon.
The use of the image intensifier requires the arm to be brought into a lateral position.
There are two possible positions for the C-arm:
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 up to the shoulder.
Preparing the whole arm allows application of a sterile tourniquet if required.
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 screen should allow a direct view for the surgeon.
The setup with the arm over the chest is useful for access to the olecranon.