20 Arthroscopic procedures 20

20 Arthroscopic procedures

20.1 Shoulder – 268

20.1.1 Beach-chair position – 268 20.1.2 Lateral position – 270

20.2 Hips – 272

20.2.1 Supine position on the extension table – 272

20.3 Knee – 274

20.3.1 Supine position – 274

20.4 Foot/ankle – 276

20.4.1 Supine position – 276

20 ^20.1 Shoulder

20.1.1 Beach-chair position

. Figs. 20.1–20.5.

Indications

drome, rotator cuff rupture, tendinosis calcarea, shoulder instability, arthrosis/

osteolysis of the acromioclavicular joint and synovitis.

Preparations

4

Arm positioning devices

Horseshoe-shaped headrest

Remove the Gilchrist bandage

4

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

4

Beach-chair operating table position 2 or universal operating table with shoulder 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

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 oper- ating table until the final position is reached

4

Change the Bowden cable over and lower the legs to the horizontal (system

Position the head on a horseshoe-shaped headrest and fix with transparent plaster right across the forehead or use a head holder for shoulder opera- tion (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 posi- tioning device

4

Apply the neutral electrode and connect to the HF surgery device

Fit the thorax support to the rail of the shoulder plate

4

Arrange self-adhesive covers for preoperative skin disinfection

Position the operating lights

4

Patient warming system Risks

4

Diagnostic and therapeutic arthroscopy procedures for impingement syn-

1120)

Nerve injuries (brachial plexus)

. Fig. 20.5. Thorax support

. Fig. 20.1. Beach-chair positioning on special shoulder plate with helmet for safe positioning of the head

. Fig. 20.2. The thorax support offers additional safety

. Fig. 20.3. The universal operating table with special shoulder plate is adapted to the body

. Fig. 20.4. A segment is removed to leave free access to the rear shoulder

20.1 · Shoulder

20 ^{20.1.2 Lateral position}

. Figs. 20.6, 20.7.

Indications

drome, rotator cuff rupture, tendinosis calcarea, shoulder instability, arthrosis/

osteolysis of the acromioclavicular joint and synovitis.

Preparations

4

Arm positioning devices

4

Gel ring, gel cushion, Goepel leg holder, side supports, radial adjusting clamps, padded cushions (normal and flat) and wedge cushions, tunnel cushions, body belts

4

Gallows for arm extension

4

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

4

table

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 1st possibility:

fit the radial adjusting clamp to the side rail of the head plate and position the Goepel leg holder

4 2nd possibility:

fit gallows for suspending the arm being operated with counterweight (extension) to the foot end of the operating table

4

Spread out the arm on the side not being operated

not lie directly on the shoulder

4

Fit the body supports to the side rails and brace on the level of the sacrum and symphysis

4 1st possibility:

position the legs with the padded cushions (normal and flat) and possibly wedge cushions

4

Fix the lower leg and the positioning aids with the body belts

position the legs with the tunnel cushion

Apply the neutral electrode and connect to the HF surgery device

4

Arrange absorbent drapes or self-adhesive covers for preoperative skin disinfection

4

Position the operating lights without switching on

Patient warming system

Diagnostic and therapeutic arthroscopy procedures for impingement syn-

Standard operating table position 1, position 2 or universal operating

Move the patient onto the healthy side

Move the lower arm forwards so that the weight of the upper body does

. Fig. 20.6. Lateral position with arm exten- sion

. Fig. 20.7. Arm extension (gallows) can be swivelled and adjusted in height

20.1 · Shoulder

20 ^{20.2 Hips}

20.2.1 Supine position on the extension table

. Figs. 20.8, 20.9.

Indications

synovitis, fractures, labrum lesions and arthrosis.

Preparations

4

Arm positioning devices

44

Shaving in the area of the incision and preoperative skin cleansing

Positioning

4

Universal operating table for traumatology and orthopaedic procedures (extension table)

4

Anaesthetic preparation and induction in supine position with 2 adapted arm positioning devices

4

If necessary, diagonal positioning of the operating table in the theatre

When positioning the patient, take appropriate measures to prevent

decubitus at areas which are subjected to pressure

4

Insert the countertraction bar on the side being treated

4

Insert the long telescopic bar in the extension bar on the side not being operated

4

Insert the short telescopic bar in the extension bar on the side being operated

4

Fit the foot plate adapter

Fit the screw tension device

4

Fit the rotation tilt clamp to the screw tension device

Position the foot plates

4

Fit the positioned foot plates to the screw tension device and foot plate adapter, constantly pulling the legs at the rotation and tilting clamp

Remove the (extension table) leg plates

4

Position the arms

4

Position the legs and set up the image intensifier

Check all screwed and clamped connections

4

Apply the neutral electrode and connect to the HF surgery device

Arrange self-adhesive covers for preoperative skin disinfection

Position the operating lights without switching on

4

Patient warming system

Risks

Diagnostic and therapeutic arthroscopic procedures for floating cartilage,

Extension table accessories G-arm, alternatively 1 or 2 C-arms

Longitudinal adjustment of the operating table towards the feet (1150.20) Swivel the extension bars in a V-shape towards the feet

Nerve injuries (pudendal nerve)

. Fig. 20.8. Supine position on extension table with G-arm

. Fig. 20.9. Positioning the monitors at the foot end; foot holder closure is located on the inside for better padding of the feet on the outside

20.2 · Hips

20 ^{20.3 Knee}

20.3.1 Supine position

. Figs. 20.10–20.15.

Indications

meniscus lesions, cartilage damage, arthrosis, floating cartilage, synovitis, fractures and osteochondrosis dissecans.

Preparations

4

Arm positioning devices

4

Tourniquet, cotton wool padding, elastic bandages, perforated rubber sheet knee holder, special positioning cushion

4

Shaving in the area of the incision and preoperative skin cleansing

Apply a tourniquet in position

Positioning

table

4

Anaesthetic induction in the supine position, padding under the shoul- ders

44

When positioning the patient, take appropriate measures to prevent decubitus at areas which are subjected to pressure

4

position

4

Fit the knee holder with radial adjusting clamp to the small rail of the leg plate on the operation side

4

Fix the thigh in the knee holder

4

Position the leg not being operated on the special positioning cushion

Apply the neutral electrode and connect to the HF surgery device

4

Connect the compressed air supply to the tourniquet

4

Preoperative skin disinfection as far as the perforated rubber sheet

Position the operating lights without switching on

4

Patient warming system Risks

44

Injury to the femoral nerve under hyperextension of the other hip, there- fore positioning cushion (black) under the other thigh

Diagnostic and therapeutic arthroscopic procedures for ligament injuries,

Standard operating table position 1, position 2 or universal operating

Normal positioning of the operating table in the theatre

Position both arms on the arm positioning devices in 45° abduction

(MHH), with abduction of the leg and swing down the leg plate

Dislocation in the leg holder

. Fig. 20.10. Supine position on universal operating table with 4-sec- tion leg plates

. Fig. 20.11. Lower segment of the leg plate folded down and thigh fixed in a knee holder

. Fig. 20.12. Thigh padded to prevent pressure from the knee holder, at the same time this acts as tourniquet

. Fig. 20.13. Healthy leg lowered and abducted, thigh padded/raised with special positioning cushion (MHH) to prevent hyperextension in the hip joint

. Fig. 20.14. Preoperative skin disinfection up to the perforated rubber sheet

. Fig. 20.15. Special covering for arthroscopy of the knee 20.3 · Knee

20 ^20.4 Foot/ankle

20.4.1 Supine position

. Figs. 20.16–20.20.

Indications

cartilage damage, arthrosis, floating cartilage, synovitis, fractures and osteo- chondrosis dissecans.

Preparations

4

Arm positioning devices

4

Shaving in the area of the incision and preoperative skin cleansing

Positioning

table

4

Anaesthetic induction in the supine position, padding under the shoul- ders

44

When positioning the patient, take appropriate measures to prevent decubitus at areas which are subjected to pressure

4

position

4

Apply the tourniquets in position:

4 1st possibility:

lower leg only, here padding and tourniquet

thigh for tourniquet and lower leg for padding

holder with the radial adjusting clamp to the rail of the leg plate in a raised position at the middle of the calf, so that the leg being operated is in a horizontal position as far as possible

4

Fix the lower leg in the leg holder

4

Position the leg not being operated on the special positioning cushions, with abduction of the leg and swing down the leg plate

4

Apply the neutral electrode and connect to the HF surgery device

Connect the compressed air supply to the tourniquet

4

Preoperative skin disinfection as far as the perforated rubber sheet

Position the operating lights without switching on

4

Patient warming system Risks

44

Pressure injuries caused by the tourniquet

Diagnostic and therapeutic arthroscopic procedures for ligament injuries,

4

Standard operating table position 1, position 2 or universal operating 1 to 2 tourniquets, cotton wool padding, elastic bandages, perforated rubber sheet, knee holder, special positioning cushion

Normal positioning of the operating table in the theatre

Position both arms on the arm positioning devices in 45° abduction

Lower the leg plate on the operation side by about 30° and fit the knee

Nerve lesions caused by the arthroscopy

. Fig. 20.16. Supine position on universal operating table with 4-sec- tion leg plates

. Fig. 20.17. Knee holder fitted to the side rail of the lower segment of the leg plate lowered through about 30°; a tourniquet is fitted to the lower leg

. Fig. 20.18. Two tourniquets are positioned; the tourniquet at the lower leg is only for padding

. Fig. 20.19. Healthy leg lowered and abducted, thigh padded/raised with special positioning cushion (MHH) to prevent hyperextension in the hip joint

. Fig. 20.20. Preoperative skin disinfection up to the perforated rubber sheet

20.4 · Foot/ankle