Shoulder

17.1.1 Supine position

O Figs. 17.1, 17.2. Indications

Ventral, axillary, transdeltoid access to the shoulder joint, access to the clavicle and to the acromioclavicular joint for fractures, pseudarthrosis, posttraumatic misalignment, luxation, instability, tumours, inflammation and rupture of the biceps tendon.

Preparations

4 Arm positioning devices 4 Remove Gilchrist bandage 4 Gel ring

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

4 Standard operating table position 1, position 2 or universal operating table with X-ray protection, clavicle remains available for scanning 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 Tilt the operating table in the Trendelenburg position, raise the back plate by 20-30°, lower the leg plates and the head section by hand 4 Position the head on a gel ring, possibly slightly turned to the other side and reclined

4 Position the infusion arm on an arm positioning device 4 Pad the shoulder with a positioning aid, thus raising the operating site or joint being operated 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 positioning device

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

Fig. 17.1. Supine position with arms positioned at the body (arm protection with padding)

17.1.2 Beach-chair position

O Figs. 17.3-17.7. Indications

Ventral, transdeltoid access to the shoulder joint, access to the clavicle and to the acromioclavicular joint for fractures, pseudarthrosis, posttraumatic misalignment, luxation, instability, tumours, inflammation, rupture of the biceps tendon, arthrosis, impingement syndrome and rotator cuff lesions.

Preparations

4 Arm positioning devices 4 Remove Gilchrist bandage 4 Gel ring

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

Positioning

4 Beach-chair (BC) operating table position 2 or universal operating table with special back plate 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 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 operating table until the final position is reached 4 Change the Bowden cable over and lower the legs to the horizontal position (system 1120)

4 Position the head on a gel ring and fix with transparent plaster right across the forehead or use a head support for shoulder operation (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 positioning device

4 Apply the neutral electrode and connect to the HF surgery device 4 Fit the thorax support to the side rail of the shoulder plate 4 Arrange self-adhesive covers for preoperative skin disinfection 4 Position the operating lights 4 Patient warming system

Risks

4 Iatrogenic injuries to the eyes and soft tissues (head fixing) when fixed with plaster or foil 4 Secondary dislocation

D Fig. 17.3. Beach-chair positioning on special shoulder plate with helmet for safe positioning of the head

Fig. 17.4. The thorax support offers additional safety

Fig. 17.4. The thorax support offers additional safety

□ Fig. 17.5. The universal operating table with special shoulder plate is adapted to the body

□ Fig. 17.6. A segment is removed to leave free access to the rear shoulder

Fig. 17.7. Thorax support

O Figs. 17.8, 17.9. Indications

Dorsal and transacromial access to the shoulder joint and access to the scapula for luxation, fractures, posttraumatic misalignment, instability, tumours, rotator cuff lesions.

Preparations

4 Arm positioning devices

4 Special head positioning cushion for prone position 4 Thorax, pelvic and wedge cushion, padded roll 4 Shaving in the area of the incision and preoperative skin cleansing

Positioning

4 Standard operating table position 1, position 2 or universal operating table

4 Anaesthetic preparation and induction in supine position with 2 adapted arm positioning devices 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 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 Position the head on the special head positioning cushion 4 Position both arms on the arm positioning devices 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

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