Positioning Techniques in Surgical Applications - part 9 ppsx

Chapter 18 · Lower extremitiesPreparations 4 Arm positioning devices 4 Wedge cushion, body support 4 Shaving in the area of the incision and preoperative skin cleansing 4 Apply a tourniq

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. 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 . Fig 18.33 Lateral fluoroscopy of the tibia with left leg lowered

18.4 · Lower leg

Chapter 18 · Lower extremities

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

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

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. 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

18.5 · Foot

Chapter 18 · Lower extremities

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

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 tion the body supports on the level of the coccyx and symphysis

posi-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

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. Fig 18.40 Legs positioned on

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 Fig 18.42 Lateral positioning on CRP operating table 1150.16 with CRP accessory adapter

. Fig 18.41 Legs positioned on divided CRP

leg plates with tunnel cushion

18.5 · Foot

Chapter 18 · Lower extremities

4 Arm positioning devices

4 Shaving in the area of the incision and preoperative skin cleansing

4 Apply a tourniquet in position

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

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. 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-18.5 · Foot

19 Positioning on the extension table

19.1 Extension table proximal femur – 260

Chapter 19 · Positioning on the extension table

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

44

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 rated

ope-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 accessoriesG-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)

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. Fig 19.1 Operating table 1150.20 with foot plates fitted for

both legs

. Fig 19.2 Operating table 1140.20 with foot plates fitted for both

legs and use of the G-arm

. Fig 19.3 Operating table 1140.20 with foot plates fitted for both

legs and use of the G-arm for DHS operation (DHS, dynamic hip screw)

. Fig 19.5 Foot plate fitted to the rotating and tilting clamp with

. Fig 19.4 Preoperative skin disinfection

19.1 · Extension table proximal femur

Chapter 19 · Positioning on the extension table

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

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4 Insert the countertraction post on the side being treated

4 Insert the short telescopic bar in the extension bar on the side being operated

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 rails of the lower back plate on the side not being operated

4 Fit the side rail extension to the side rail of the seat plate

4 Fit the Goepel leg holder to the side rail extension with a radial adjusting clamp

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

4 Transfer the patient from the induction table to the prepared operating table in supine position

4

rotation, constantly pulling the leg

4 Position the left leg in the Goepel leg holderPosition the arms

4 Reposition the fracture using the image intensifier

4 To stabilise the patient, possibly support the thorax from the side

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 Iatrogenic damage caused by inserting the Steinmann nail

4 Pressure injuries

4 Compartment syndrome from overdistraction

Medullary nailing, intramedullary reaming

Extension table accessories

Longitudinal adjustment of the operating table towards the feet (1150.20)Swivel the extension bars in a V-shape towards the feet on the side being operated

Fit the Kirschner wire bow before transferring the patient

Fit the positioned Kirschner wire bow to the traction stirrup clamp with

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. Fig 19.6 Operating table 1150.20 with

fitted foot plate, healthy leg is in abduction

on a Goepel leg holder

19.2 · Extension table thigh

. Fig 19.7 Operating table 1150.20 with

fitted Kirschner wire bow and thorax support

. Fig 19.8 Operating table 1150.20 with

fitted foot plate, healthy leg is positioned

Chapter 19 · Positioning on the extension table

4 Two arm positioning devices

4 Shaving in the area of the incision and preoperative skin cleansing

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 fe

4 Fit the tibia device to the seat plate on the side being operated

4 Unlock the unit at the lower radial joint and lower towards the feet to improve scanning the knee in anteroposterior ray path after positioning

4 Lock the safety lever again

4 Insert the short telescopic bar in the extension bar on the side being operated

4 Fit the screw tension device

4 Fit the rotation tilt 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 side rails extension to the side rail of the seat plate

4 Fit the Goepel leg holder to the side rail extension with a radial adjusting clamp

4 Fit the anaesthesia screen with a radial adjusting clamp to the side rail of the upper back plate on the side not being operated

4 Fit the anaesthesia screen extensions and possibly suspend 2 arm straps

4 Fit the tension hoop before transferring the patient

4 Transfer the patient from the induction table to the prepared operating table in supine position

4

rotation, constantly pulling the leg

4 Position the healthy leg in the Goepel leg holder

4 Position the arms

4 Reposition the fracture using the image intensifier

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 Iatrogenic damage caused by inserting the Steinmann nail

4 Pressure injuries

4 Compartment syndrome from overdistraction

Medullary nailing, intramedullary reaming

et (1150.20)

Fit the positioned Kirschner wire bow to the traction stirrup clamp with

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. Fig 19.9 Operating table 1150.20 with

tibia device and fitted Kirschner wire bow, healthy leg is spread out on a Goepel leg holder

. Fig 19.11 Image intensifier in lateral

. Fig 19.10 Tibia device is lowered to

optimise anteroposterior fluoroscopy

19.3 · Extension table lower leg

Chapter 20 · Arthroscopic procedures

4 Remove the Gilchrist bandage

4 Shaving in the area of the incision and preoperative skin cleansing

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 ating table until the final position is reached

oper-4 Change the Bowden cable over and lower the legs to the horizontal (system

4 Position the head on a horseshoe-shaped headrest and fix with transparent plaster right across the forehead or use a head holder for shoulder opera-tion (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 posi-tioning device

4 Apply the neutral electrode and connect to the HF surgery device

4 Fit the thorax support to the rail of the shoulder plate

4 Arrange self-adhesive covers for preoperative skin disinfection

4 Position the operating lights

4 Patient warming system

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. Fig 20.5 Thorax support

. Fig 20.1 Beach-chair positioning on special shoulder plate with

helmet for safe positioning of the head

. Fig 20.2 The thorax support offers additional safety

. Fig 20.3 The universal operating table with special shoulder plate

is adapted to the body

. Fig 20.4 A segment is removed to leave free access to the rear

shoulder

20.1 · Shoulder

Chapter 20 · Arthroscopic procedures

4 Arm positioning devices

4 Gel ring, gel cushion, Goepel leg holder, side supports, radial adjusting clamps, padded cushions (normal and flat) and wedge cushions, tunnel cushions, body belts

4 Gallows for arm extension

4 Shaving in the area of the incision and preoperative skin cleansing

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 1st possibility: fit the radial adjusting clamp to the side rail of the head plate and position the Goepel leg holder

4 2nd possibility: fit gallows for suspending the arm being operated with counterweight (extension) to the foot end of the operating table

4 Spread out the arm on the side not being operated

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not lie directly on the shoulder

4 Fit the body supports to the side rails and brace on the level of the sacrum 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 Arrange absorbent drapes or self-adhesive covers for preoperative skin disinfection

4 Position the operating lights without switching on

4 Patient warming system

Diagnostic and therapeutic arthroscopy procedures for impingement

syn-Standard operating table position 1, position 2 or universal operating

Move the patient onto the healthy sideMove the lower arm forwards so that the weight of the upper body does