Upper arm

17.2.1 Supine position

O Figs. 17.10-17.13. Indications

Extended ventral access to the shoulder joint and ventral, medial and lateral access to the humerus for fractures, pseudarthrosis, posttraumatic misalignment, tumours, inflammation, nerve lesions.

Preparations

4 Arm positioning devices 4 Remove Gilchrist bandage

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 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 fasten 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 Arrange self-adhesive covers for preoperative skin disinfection 4 Position the operating lights 4 Patient warming system

D Fig. 17.10. Arm positioning on large arm table

D Fig. 17.10. Arm positioning on large arm table

Prone Theatre CushionProne Theatre Cushion

O Figs. 17.14-17.16. Indications

Dorsal access to the humerus for fractures, pseudarthrosis, posttraumatic misalignment, tumours, inflammation, nerve lesions.

Preparations

4 Arm positioning devices

4 Special head positioning cushion for prone position 4 Thorax, pelvic and wedge cushion, padded roll 4 Small arm rest, X-ray protection, C-arm (poss. G-arm) in the theatre 4 Remove Gilchrist bandage

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 the infusion arm on the arm positioning device 4 Position the patient near to the edge of the table, until the injured/fractured arm hangs at the elbow over the edge of the small arm rest with the lower arm in a vertical position 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

D Fig. 17.16. Use of the image intensifier on the head side (here in anteroposterior position) offers optimum scope for swivelling round

17.3 Elbow 17.3.1 Supine position

O Figs. 17.17-17.20. Indications

Lateral, medial, ventral and dorsal access to the elbow for fractures, posttraumatic misalignment, floating cartilage, inflammation, arthrosis, arthrofibrosis, soft tissue lesions, nerve lesions and contractures.

Preparations

4 Arm positioning devices 4 Remove Gilchrist bandage 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 in abduction 4 1st arm table: remove the arm positioning device and fasten the large arm table to the 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

Prone Theatre CushionProne Theatre Cushion

O Figs. 17.21-17.23. Indications

Dorsal access to the elbow for fractures, posttraumatic misalignment, floating cartilage, inflammation, arthrosis, arthrofibrosis, soft tissue lesions, nerve lesions and contractures.

Preparations

4 Arm positioning devices

4 Special head positioning cushion for prone position, thorax, pelvic and wedge cushion, padded roll 4 Small arm rest, X-ray protection, C-arm (poss. G-arm) in the theatre 4 Remove Gilchrist bandage

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

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 the infusion arm on the arm positioning device 4 Position the patient near to the edge of the table, until the injured/fractured arm hangs at the elbow over the edge of the small arm rest with the lower arm in a vertical position 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

Neutral Head Position Device Donut
D Fig. 17.21. Prone position with small arm plate/upper arm plate

D Fig. 17.22. The distal joint is positioned lower than the proximal joint

D Fig. 17.23. The small arm plate/upper arm plate should have a narrow surface so that the arm can be bent

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