16 Pelvis
16.1 Pelvic girdle – 204 16.1.1 Supine position – 204 16.1.2 Lateral position – 206 16.1.3 Prone position – 208
16.2 Acetabulum – 210
16.2.1 Supine position – 210
16.2.2 Lateral position – 212
16.2.3 Prone position – 214
16
16.1 Pelvic girdle
16.1.1 Supine position
. Figs. 16.1–16.6.
Indications
Access to the front pelvic girdle, ilium, iliosacral joint and hip joint (Pfannen- stiel, modified Stoppa, ilioinguinal, anterolateral,
operating:
4
fractures, misalignment and posttraumatic lesions in the front pelvic girdle, ilium, iliosacral joint and at the symphysis
4
tumours, osteomyelitis, ossification
4tamponade for pelvic bleeding
4placement of the pelvic cingulum Preparations
4
Arm positioning devices
4Possibly table extension
4
Shaving in the area of the incision and preoperative skin cleansing Positioning
4
Standard operating table position 1, position 2 or universal operating table, possibly table extension
4
Anaesthetic preparation and induction in supine position with 2 adapted arm positioning devices
44
When positioning the patient, take appropriate measures to prevent decubitus at areas which are subjected to pressure
4
Position both arms in the abduction position on the arm positioning devices
4
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
4Patient warming system
Judet, Smith-Peterson) for
Normal positioning of the operating table in the theatre
. Fig. 16.1. Supine position on universal operating table with CRP back plate 1150.45 and supported extension plate
. Fig. 16.2. By using the narrow CRP back plate 1150.45, the Iso-C3D can also be used in the supine position without any problems
. Fig. 16.3. Supine position on the CRP operating table 1150.16, using the image intensifier
. Fig. 16.4. Arms positioned with maximum 90° abduction and in supination position for 360° use of the image intensifier
. Fig. 16.6. Use of the image intensifier after placing a pelvis fixator . Fig. 16.5. System 1120 with leg plate extension
16
16.1.2 Lateral position
. Figs. 16.7–16.9.
Indications
Lateral, anterolateral and rear access to the ilium and iliosacral joint for operating:
4
fractures, misalignment and posttraumatic lesions of the ilium, pelvic column and iliosacral joint
4
tumours, osteomyelitis, ossification, gluteal compartment syndrome
4exposure of the sciatic nerve
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, possibly table extension
4
Shaving in the area of the incision and preoperative skin cleansing Positioning
4
Standard operating table position 1, position 2 or universal operating table, possibly table extension
4
Anaesthetic preparation and induction in supine position with 2 adapted arm positioning devices
44
When positioning the patient, take appropriate measures to prevent decubitus at areas which are subjected to pressure
4
Fit the radial adjusting clamp to the rail of the head plate, position the Goepel leg holder
4
Spread out the arm on the side not being operated
44not lie directly on the shoulder
4
Fit the radial adjusting clamps to the side rails of the leg plates/head plate and position the body supports on the level of the sacrum of the symphysis and the scapula
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
4 2nd possibility:position the legs with the tunnel cushion
4Apply 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
4Patient warming system
Normal positioning of the operating table in the theatre
Move the patient onto the healthy side
Move the lower arm forwards so that the weight of the upper body does
. Fig. 16.9. Lateral position on universal operating table with lateral positioning cushion and operating table in flex position for neutral position of the spinal column . Fig. 16.7. Lateral position on CRP operating table 1150.16 with 2 CRP accessory adapters and lateral positioning cushion for anatomic positioning of the lower arm
. Fig. 16.8. Lateral position on universal operating table with vacuum mat
16
16.1.3 Prone position
. Figs. 16.10–16.13.
Indications
Dorsal access to the sacrum, hip joint, iliosacral joint for:
4
fractures, misalignment and posttraumatic lesions in the area of the sacrum, iliosacral joint and hip joint
4
tumours, gluteal compartment syndrome
4exposure of the sacral nerve and the sciatic nerve Preparations
4
Arm positioning devices
4
Special head positioning pillow for prone position
4Thorax, pelvic and wedge cushion, padded roll
4Possibly table extension
4
Shaving in the area of the incision and preoperative skin cleansing Positioning
4
Standard operating table position 1, position 2 or universal operating table
4
Anaesthetic preparation and induction in supine position with 2 adapted arm positioning devices
4
Transfer to the prepared operating table in the induction room
4Position both tables next to each other, with the prepared table lowered
4Place the patient in prone position on the padded cushion of the prepared
operating table and take him into the theatre
44
When positioning the patient, take appropriate measures to prevent decubitus at areas which are subjected to pressure
4
Position the head on the special head positioning cushion
4Position both arms on the arm positioning devices
4
Apply the neutral electrode and connect to the HF surgery device
4Arrange self-adhesive covers for preoperative skin disinfection
4Position the operating lights
4
Patient warming system
. Fig. 16.10. Prone position on CRP ope r- ating table 1150.16 with CRP head plate for 360° use of the image intensifier
Normal positioning of the operating table in the theatre
. Fig. 16.11. Prone position on universal operating table 1150.30 with arms positioned in maximum 90° abduction
. Fig. 16.13. Prone position on universal operating table 1150.30 with maximum longitudinal displacement toward the head for optimum use of the image intensifier . Fig. 16.12. Prone position on universal operating table 1150.30 with bolsters (MHH) and use of the image intensifier
16
16.2 Acetabulum
16.2.1 Supine position
. Figs. 16.14–16.17.
Indications
access, Smith-Peterson access, extended iliofemoral access, extended Pfannen- stiel access, modified Stoppa access.
Preparations
4
Arm positioning devices
4
Shaving in the area of the incision and preoperative skin cleansing Positioning
4
Standard operating table position 1, position 2 or universal operating table
4
Anaesthetic preparation and induction in supine position with 2 adapted arm positioning devices
44
When positioning the patient, take appropriate measures to prevent decubitus at areas which are subjected to pressure
4
Position both arms in abduction position on the arm positioning devices
4Apply 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
4Patient warming system
. Fig. 16.14. Supine position on universal operating table with CRP back plate 1150.45 and supported extension plate
Operations for acetabulum fractures using the following access: ilioinguinal
Normal positioning of the operating table in the theatre
. Fig. 16.17. Arms positioned in maximum 90° abduction and in supination position for 360° use of the image intensifier
. Fig. 16.16. Supine position on CRP oper- ating table 1150.16 with use of the image intensifier
. Fig. 16.15. By using the narrow CRP back plate 1150.45, the Iso-C3D can also be used in the supine position without any problems
16
16.2.2 Lateral position
. Figs. 16.18–16.20.
Indications
Langenbeck access, combined ventral/dorsal access, extended access.
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
Shaving in the area of the incision and preoperative skin cleansing Positioning
4
Standard operating table position 1 or universal operating table
4
Anaesthetic preparation and induction in supine position with 2 adapted arm positioning devices
44
When positioning the patient, take appropriate measures to prevent decubitus at areas which are subjected to pressure
4
Fit the radial adjusting clamp to the side rail of the head plate, position the Goepel leg holder
4
Spread out the arm on the side not being operated
44not lie directly on the shoulder
4
Fit the radial adjusting clamps to the side rails of the leg plates/head plate and position the body supports on the level of the sacrum of the symphysis and the scapula
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
4 2nd possibility:position the legs with the tunnel cushion
4Apply 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
4Patient warming system
Operations for acetabulum fractures using the following access: Kocher-
Normal positioning of the operating table in the theatre
Move the patient onto the healthy side
Move the lower arm forwards so that the weight of the upper body does
. Fig. 16.18. Lateral position on CRP oper- ating table 1150.16 with 2 CRP accessory adapters and lateral positioning cushion for anatomic positioning of the lower arm
. Fig. 16.19. Lateral position on universal operating table with vacuum mat
. Fig. 16.20. Lateral position on universal operating table with lateral positioning cushion and operating table in flex position for neutral position of the spinal column
16
16.2.3 Prone position
. Figs. 16.21–16.24.
Indications
Preparations
4
Arm positioning devices
4
Special head positioning cushion for prone position
4Thorax, pelvic and wedge cushion, padded roll
4
Shaving in the area of the incision and preoperative skin cleansing Positioning
4
Standard operating table position 1, position 2 or universal operating table
4
Anaesthetic preparation and induction in supine position with 2 adapted arm positioning devices
4
Transfer to the prepared operating table in the induction room
4Position both tables next to each other, with the prepared table lowered
4Place the patient in prone position on the padded cushion of the prepared
operating table and take him into the theatre
44
When positioning the patient, take appropriate measures to prevent decubitus at areas which are subjected to pressure
4
Position the head on the special head positioning cushion
4Position both arms on the arm positioning devices
4
Apply the neutral electrode and connect to the HF surgery device
4Arrange self-adhesive covers for preoperative skin disinfection
4Position the operating lights
4
Patient warming system
. Fig. 16.21. Prone position on CRP oper- ating table 1150.16 with CRP head plate for 360° use of the image intensifier
Operations for acetabulum fractures using the Kocher-Langenbeck access.
Normal positioning of the operating table in the theatre
. Fig. 16.22. Prone position on universal operating table 1150.30 with arms positioned in maximum 90° abduction
. Fig. 16.24. Prone position on universal operating table 1150.30 with maximum longitudinal displacement towards the head for optimum use of the image intensifier . Fig. 16.23. Prone position on universal operating table 1150.30 with bolsters (MHH) and use of the image intensifier
