Chapter 21: Orthopedic Surgery; Short Answer: Arm Surgery; Hip Surgery

What are the three main advantages of maintaining laminar airflow in the operating room (OR) during a surgical procedure? Why are spacesuits used?

1) Highly filtered air (less likely to contaminate) 2) Flow of air is in one direction 3) Continuous air exchanges to reduce the microbial count. Body exhaust suits or spacesuits that have batteries for airflow are used to limit microbial fallout from the sterile team.

When is the most likely time for contamination to occur during orthopedic surgeries? What can be done to reduce the possibility of contamination of the surgery?

Contamination commonly occurs during draping; to reduce the possibility of contamination of the surgery, you can replace gloves after draping.

What are the common reasons for a total hip arthroplasty?

Incapacitating pain in patients older than 65, rheumatoid arthritis, ankylosing spondylitis, Degenerate joint disease (DJD), avascular necrosis of the hip joint due to previous fracture or dislocation, alcoholism, systemic lupus erythematous, nonunion of femoral neck and/or trochanteric fractures, TB, congenital lunation or subluxation, and bone tumor of the acetabulum, of proximal femur.

Why should part of the workup for the THA include a type and crossmatch?

The average blood loss during THA is 1000-1500mL, so the possibility of blood transfusion is high.

What are the types of hip fractures?

The operative hip fractures that require ORIF are interochanteric, subtrochanteric, femoral neck, and basilar neck fractures.

Put the following steps of an open reduction internal fixation using plates and screws in order. (1-11)

1) Pass elevator so surgeon can elevate the periosteum using elevator of surgeon's choice, such as Key, Hibbs, Hoke, Langenbeck, etc. 2) Reduce fracture using self-retaining bone clamps such as a Lane, Kern, Lewin, or Lowman. 3) Plate is selected and bent prn to fit the angles of the bone using plate benders. 4) Pass plate, usually five or six holes, and bone- or plate-holding forceps to secure plate in place. 5) Pass drill with drill bit and drill guide for the first hole (after completing pretest-runs true with appropriate speed.) 6) Pass depth gauge to measure the length of the drill hole-surgeon will state the length, which should be recorded so the appropriate screw is selected. 7) Pass T-handle tap if not a self-tapping screw. (select correct size screw, confirm correct length by measuring and load the screw while surgeon is tapping.) 8) Pass the first screw secured on screwdriver, ensuring safe if it becomes loose (hand under). State the size and length of screw. 9) While surgeon is placing screw, prepare order again-drill with drill bit and drill guide prn, measure with depth gauge, tap prn with T-handle tap and screw. 10) Pass drill with drill bit, depth gauge, tap prn, and screwdriver with subsequent screws for subsequent holes. 11) Surgeon will remove clamps. Pass irrigation and then suture to close. Count.

During the orthopedic procedure, there are duties for the surgical technologist. Identify the actions to take for each of these events. 1) Drilling or reaming through bone 2) Passing rongeur 3) Passing reamers, rasps, or anything that has progressive sizes 4) Bits of tissue and bone in lap sponge; shavings from acetabular reamer 5) Trial implant ROM tested; physician confirms sizes 6) Excess cement removed from around the cemented component

1) ST action: Familiarize self with instruments; Reason: Safety 2) ST action: Remove bone and tissue bits; Reason: Keep clean for surgeon, specimen 3) ST action: Remove bone and tissue bits, rinse off; Reason: Keep clean, helps for when sterilizing instruments 4) ST action: Save on sponge or towel, possible specimen or graft; Reason: Make sure to not get rid of any specimen 5) ST action: Remember sizes for the actual implant; Reason: Do not want to have to open more than one implant, money 6) ST action: Have small piece on back table that is rolled into ball; Reason: Check cement piece for hardness

Describe colles' fracture.

A fracture of the distal radius that occurs at the epiphysis within 254 cm of the wrist joint, forcing the hand into a dorsal and lateral position.

After the incision is made, what is the first step for a DHS/DCS (dynamic hip screw/dynamic compression screw) procedure? What is the usual size for a DHS plate and barrel?

A guide pin is placed; The standard 38mm barrel length for the plate and 135 degree barrel angle is most commonly used.

What type of drape is commonly used with IV poles?

A large barrier drape that has adhesive to stick to hip and is draped over three IV poles and extends close to the floor.

What is used to prepare the site for the placement of the DHS plate and screw?

A triple reamer is placed over the guide pin to ream for the lag screw, countersink the plate and barrel junction, and ream the plate barrel.

As part of the postoperative care, what is placed to immobilize the joint?

An abduction triangular splint is placed in between the legs to immobilize the joint.

What is the most common method of reduction for a colles' fracture?What are the components of the device?

An external fixation device. A frame is placed over the pins and the clamps are secured. Tightening the clamps holds the fracture in reduction.