Surgeries

Published on 05/05/2017 by admin

Last modified 22/04/2025

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FIG. 7.18 Human skeleton. The axial skeleton is distinguished by a blue tint. A, Anterior view. B, Posterior view. (From Patton KT, Thibodeau GA: The human body in health & disease, ed 6, St Louis, 2014, Mosby.)

• Arthroscopy of the shoulder (acromioplasty)

• Arthroscopy of the hip

• Arthroscopy of the ankle

Basic Equipment for Arthroscopic Procedures

• Basic orthopedic instrument tray

• Irrigation tubing and pump

• Arthroscopic tower

• Tourniquet

• Arthroscopic instrument tray

• Arthroscope with 30- and 70-degree lenses

• Arthroscopic shaver

• Camera

• Light source and cord

• 3000-mL bags of fluid (distention medium)

• Power drill and saw

FIG. 7.19 Beach chair–style shoulder positioner allows distraction of the joint for visualization. (From Rothrock JC, Alexander SM: Alexander’s surgical procedures, ed 1, St. Louis, 2012, Mosby.)

• Suture anchors

• Beach chair positioner (for shoulder procedures; Fig. 7.19)

Additional Facts to Remember

• The patient is placed in the supine position/modified “beach chair” (Fowler) position for shoulder surgeries.

• For knee operations, the patient is placed in the supine/lateral position with the knee to be operated on placed below the break of the table.

• Before any arthroscopic procedure, you must check all videoscopic equipment, prime the pump, and white-balance the scope.

• Remember to monitor fluid input and output during procedure.

• Remember to monitor tourniquet time carefully:

• The surgeon should be informed once the cuff has been inflated for the first 60 minutes.

• The recommended inflation time for the arms is 60 minutes; it is 90 minutes for the legs.

• When the recommended time limit has been reached, the cuff should be deflated for 15 minutes to permit reperfusion of the extremity, after which the cuff may be reinflated for another recommended time period (i.e., 60 or 90 minutes).

• The limb should be re-exsanguinated before reinflation to help prevent the formation of venous thromboses.

Mapping

Here’s the map of one extremely common arthroscopic procedure:

Surgical Mapping

Arthroscopic ACL reconstruction

Instruments	Important Anatomy Involved	Pathophysiology
Arthroscopy instrumentation: arthroscope, irrigation, tubing, pump Camera Light source and cord Arthroscopic tower Fixation device, bone plugs, screws Power drill and saw Arthroscopic shaver Tourniquet	Knee Femur Tibial plateau Meniscus ACL PCL MCL	MRI findings (i.e., torn ACL)

Microbiology/Wound Classification	Skin Prep/Incision/Patient position	Pharmacology
No indigenous microorganisms in these structures Clean class I	Prep: entire leg circumferentially, from toes to groin; Extremity draping with impervious stockinette Incision: 2 stab incisions on medial & lateral knee joint capsule; vertical incision over patellar tendon (if harvesting graft from patient) Position: supine with padded lateral post; affected knee joint extended over break of table	General anesthesia, epidural, or spinal block