Forearm and hand

17.4.1 Supine position

O Figs. 17.24-17.29. Indications

Ventral, dorsal and dorsolateral access to the forearm, dorsal and palm access to the wrist and to the hand, access to the thumb and first finger for fractures, posttraumatic misalignment, pseudarthrosis, luxation, inflammation, arthro-sis, soft tissue lesions, nerve lesions, contractures, tumours, operations to tendons, synovial sheaths and carpal tunnel.

Preparations

4 Arm positioning devices 4 Remove splints from extremity 4 Large arm table

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 with X-ray protection 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 at areas which are subjected to pressure 4 Standard supine position, infusion arm is spread out 4 Remove the arm positioning device and fit the large arm table to the side rail of the back plate 4 Position the patient near to the edge of the table 4 Apply the neutral electrode and connect to the HF surgery device 4 Connect the compressed air device to the tourniquet 4 Arrange self-adhesive covers for preoperative skin disinfection 4 Position the operating lights 4 Patient warming system

Fig. 17.25. 360° fluoroscopy possibility

Fig. 17.26. Arms positioned with maximum 90° abduction in supination position

D Fig. 17.27. Arms positioned with maximum approx. 50° abduction in pronation position

Fig. 17.26. Arms positioned with maximum 90° abduction in supination position

D Fig. 17.28. The image intensifier is ready for use on the side opposite D Fig. 17.29. Operation scene the surgeon

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