19 Positioning on the extension table
19.1 Extension table proximal femur – 260 19.1.1 Supine position – 260
19.2 Extension table thigh – 262 19.2.1 Supine position – 262
19.3 Extension table lower leg – 264
19.3.1 Supine position – 264
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19.1 Extension table proximal femur
19.1.1 Supine position
. Figs. 19.1–19.5.
Indications
of extension and fluoroscopy in two levels, and displacement osteotomy of the proximal femur.
Preparations
4 Arm positioning devices
4 4 Shaving in the area of the incision and preoperative skin cleansing 4
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 4 When positioning the patient, take appropriate measures to prevent
decubitus at areas which are subjected to pressure 4 4
4 Insert the countertraction post 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 ope- rated
4 Fit the foot plate adapter 4 Fit the screw tension device
4 Fit the rotating and tilting clamp to the screw tension device 4 Place a double wedge cushion on the operating table
4 Fit the arm positioning device to the side rails of the lower back plate on the side not being operated
4 Fit the anaesthesia screen with a radial adjusting clamp to the side rail of the upper back plate on the left-hand side
4 Fit the anaesthesia screen extensions and possibly suspend 2 arm straps 4 Position the foot plates before transferring the patient
4 Transfer the patient from the induction table to the prepared operating table in supine position
4 Fit the positioned foot plates to the screw tension device and foot plate adapter, constantly pulling the legs at the rotating and tilting clamp 4 Position the arms
4 Reposition the fracture using the image intensifier and position the legs 4 Check all screwed and clamped connections
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 Risks
4 Secondary dislocation 4
Osteosynthesis of the proximal femur entailing reposition with the possibility
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 (n. pudendus)
. Fig. 19.1. Operating table 1150.20 with foot plates fitted for both legs
. Fig. 19.2. Operating table 1140.20 with foot plates fitted for both legs and use of the G-arm
. Fig. 19.3. Operating table 1140.20 with foot plates fitted for both legs and use of the G-arm for DHS operation (DHS, dynamic hip screw)
. Fig. 19.5. Foot plate fitted to the rotating and tilting clamp with padded, fixed foot
. Fig. 19.4. Preoperative skin disinfection
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19.2 Extension table thigh
19.2.1 Supine position
. Figs. 19.6–19.8.
Indications
Preparations
4 Two arm positioning devices
4 4 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 4 When positioning the patient, take appropriate measures to prevent
decubitus at areas which are subjected to pressure 4 4
4 Insert the countertraction post on the side being treated
4 Insert the short telescopic bar in the extension bar on the side being operated
4 Fit the screw tension device
4 Fit the rotating and tilting clamp to the screw tension device 4 Place a double wedge cushion on the operating table
4 Fit the arm positioning device to the rails of the lower back plate on the side not being operated
4 Fit the side rail extension to the side rail of the seat plate
4 Fit the Goepel leg holder to the side rail extension with a radial adjusting clamp
4 Fit the anaesthesia screen with a radial adjusting clamp to the side rail of the upper back plate on the left-hand side
4 Fit the anaesthesia screen extensions and possibly suspend 2 arm straps 4 4 Transfer the patient from the induction table to the prepared operating
table in supine position 4
rotation, constantly pulling the leg
4 Position the left leg in the Goepel leg holder Position the arms
4 Reposition the fracture using the image intensifier
4 To stabilise the patient, possibly support the thorax from the side 4 Check all screwed and clamped connections
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 Risks
4 Iatrogenic damage caused by inserting the Steinmann nail 4 Pressure injuries
4 Compartment syndrome from overdistraction Medullary nailing, intramedullary reaming.
Extension table accessories
Longitudinal adjustment of the operating table towards the feet (1150.20) Swivel the extension bars in a V-shape towards the feet on the side being operated
Fit the Kirschner wire bow before transferring the patient
Fit the positioned Kirschner wire bow to the traction stirrup clamp with
. Fig. 19.6. Operating table 1150.20 with fitted foot plate, healthy leg is in abduction on a Goepel leg holder
. Fig. 19.7. Operating table 1150.20 with fitted Kirschner wire bow and thorax support
. Fig. 19.8. Operating table 1150.20 with fitted foot plate, healthy leg is positioned downwards on a special support
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19.3 Extension table lower leg
19.3.1 Supine position
. Figs. 19.9–19.11.
Indications
Preparations
4 Two arm positioning devices
4 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 4 When positioning the patient, take appropriate measures to prevent
decubitus at areas which are subjected to pressure
4 Longitudinal adjustment of the operating table towards the fe 4 Fit the tibia device to the seat plate on the side being operated
4 Unlock the unit at the lower radial joint and lower towards the feet to improve scanning the knee in anteroposterior ray path after positioning 4 Lock the safety lever again
4 Insert the short telescopic bar in the extension bar on the side being operated
4 Fit the screw tension device
4 Fit the rotation tilt clamp to the screw tension device 4 Place a double wedge cushion on the operating table
4 Fit the arm positioning device to the side rails of the lower back plate on the side not being operated
4 Fit the side rails extension to the side rail of the seat plate
4 Fit the Goepel leg holder to the side rail extension with a radial adjusting clamp
4 Fit the anaesthesia screen with a radial adjusting clamp to the side rail of the upper back plate on the side not being operated
4 Fit the anaesthesia screen extensions and possibly suspend 2 arm straps 4 Fit the tension hoop before transferring the patient
4 Transfer the patient from the induction table to the prepared operating table in supine position
4
rotation, constantly pulling the leg
4 Position the healthy leg in the Goepel leg holder 4 Position the arms
4 Reposition the fracture using the image intensifier 4 Check all screwed and clamped connections
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
Risks
4 Iatrogenic damage caused by inserting the Steinmann nail 4 Pressure injuries
4 Compartment syndrome from overdistraction Medullary nailing, intramedullary reaming.
et (1150.20)
Fit the positioned Kirschner wire bow to the traction stirrup clamp with
. Fig. 19.9. Operating table 1150.20 with tibia device and fitted Kirschner wire bow, healthy leg is spread out on a Goepel leg holder
. Fig. 19.11. Image intensifier in lateral position
. Fig. 19.10. Tibia device is lowered to optimise anteroposterior fluoroscopy
