Chapter 21: Orthopedic Surgery; Short Answer: Open Reduction Internal Fixation (ORIF); Shoulder Surgery

Name the three joints of the shoulder girdle.

1) Glenohumeral joint 2) Sternoclavicular joint 3) Acromionclavicular joint

What solution is commonly used for arthroscopy? What may be added to control bleeding? Why are large bags used?

3000mL bags of lactated ringer's. To aid in hemostasis the surgeon may add 1mL of epinephrine after confirming with anesthesia an arthoscopic ESU will also be used. May also inject 5mL of marcaine with epinephrine to aid in hemostasis. Large are used to allow plenty of fluid to flow through the joint for irrigation and removal of any loose bodies.

When using PMMA bone cement, what is the importance of using a closed mixing system?

A closed mixing system that is attached to suction to exhaust the fumes created during the process of mixing the cement. The fumes are irritating to the mucous membranes and possibly toxic to the liver.

Fill in the blank: When closing the periosteum use ______ suture such as _____ or _____ and for bone use _____ suture such as ______ ______.

Absorbable; Chromic; Vicryl; Strong; Stainless Steel

Fill in the blank: The top of glenoid cavity is formed by the bony point on the top of the shoulder called the acromion process of the _____________

Acromionclavicular joint (AC)

Describe a Bankhart lesion.

An avulsion injury of the anterior capsule and labrum of the glenoid rim known as the inferior glenohumeral ligament. It is usually caused by subluxation or lunation of the joint.

When placing a trocar for the arthroscopic Bankhart repair, what type of trocars are used, and why?

Blunt, not sharp, trocars used; threaded cannulas should be used to prevent their dislodgment during the surgical procedure.

What is meant by the term exsanguination? How does this apply to extremity surgery with the use of a tourniquet?

Exsanguination: Provides a bloodless surgical field which aids in visualization. A popular tourniquet is the double-cuffed pneumatic tourniquet. Continuous pressure should not be applied for more than one hour on an upper extremity and one and a half hours on the thigh.

If you are using a fracture table, what precautions must be taken? What additional precautions are taken when the use of a C-arm is anticipated?

Fracture tables have several moving parts and can cause injury to the patient and OR personnel if not handled correctly. The unaffected leg is placed in a boot that is abducted to allow for the C-arm to be positioned over the injured site or may be placed in a leg-well holder.

What are the bony landmarks that are marked for an arthroscopic acromioplasty?

Humeral head and bony glenoid fossa.

What muscles comprise the rotator cuff? How will a tear of one or more of these muscles or their tendons attachments affect the shoulder?

Infraspinatus, teres minor, subscapularis, and supraspinatus.

What is the maximum recommended time that tourniquet pressure may be applied to an upper extremity? Why?

No more than one hour on an upper extremity because it can cause damage to the muscles, nerves and blood vessels.

What information is required regarding implant documentation?

Number of implants used, the type of implants, the size of implants, and the manufacturer's serial numbers.

What are the problems that may commonly be found and treated during the diagnostic shoulder arthroscopy?

Removal of loose bodies, bursectomy, rotator cuff repair, labral tear repair, and repair of impingement syndrome.

Review the advantages of using the continuous passive motion (CPM) machine, and select the two that you feel are the most important reasons.

Surgeon may order the use of the CPM for the patient after major knee, elbow, shoulder, and femoral surgical procedures. The CPM aids in decrease of pain and swelling at the site, reduces joint stiffness, inhibits the formation of adhesions, provides early mobilization, and decreases the effects of immobilization such as muscle wasting.

During the examination of the shoulder, how is the arm manipulated by the surgical technologist?

The ST may be asked to rotate the arm for visualization; manipulate the arm gently from the extended, externally rotated position in an internally, slightly fixed position; to slowly internally and externally rotate the shoulder to view the articular cartilages, the ST must manipulate the arm slowly to prevent damage to the shoulder joint structures and allow the surgeon to follow along with arthroscope.

Once a shoulder arthroscopy has begun, what landmark is used for orientation during the procedure? What instrument is used to palpate the structures to identify any injuries?

The biceps tendon is used as a landmark throughout the procedure. The surgeon uses the arthroscope to examine. The surgeon will place the probe through the anterior portal to examine for labral or SLAP tears or synovitis.

What type of joint is the shoulder? What bones articulate to form the joint?

The shoulder is made of three bones: 1) scapula, 2) clavicle, 3) humerus. The shoulder joint is a ball-and-socket joint.

Describe what can happen if implants are scratched or reused, or if implants with differing alloys are used from different manufacturers.

They can cause complications such as corrosion of implant, irritation, and infection of the bone. If they are composed of different alloys they will corrode causing a breakdown of the implant. This will delay healing and possibly cause an infection.

What types of alloys are used in the manufacturing process?

Titanium, stainless steel, and cobalt (chromium)

What is the main function of the rotator cuff?

To provide stability and strength to the shoulder joint.

Describe the direction of the blade motion for a reciprocating saw and an oscillating saw.

When in motion, the reciprocating saw blade moves back and forth. The oscillating saw moves side to side.