Antoci / Eltorai Outlines in Orthopaedic Surgery

1. Auflage 2020
ISBN: 978-1-63853-571-3
Verlag: Thieme
Format: EPUB
Kopierschutz: 6 - ePub Watermark

E-Book, Englisch, 286 Seiten, ePub

Reihe: Surgical Outlines

Surgery requires a combination of knowledge and skill acquired through years of direct observation, mentorship, and practice. The learning curve can be steep, frustrating, and intimidating for many medical students and junior residents. Too often, books and texts that attempt to translate the art of surgery are far too comprehensive for this audience and counterproductive to learning important basic skills to succeed. by Valentin Antoci and Adam Eltorai is the orthopaedic volume in a series of textbooks that offer a simplified roadmap to surgery. The text serves as starting point for learning orthopaedic surgery techniques, with room for adding notes, details, and pearls collected during the journey.

This unique resource outlines key steps for common orthopaedic procedures, laying a solid foundation of basic knowledge from which trainees can easily build and expand. Thirty-five chapters are systematically organized and formatted by subspecialty, starting with an introduction, followed by sections covering surgery of the hand, shoulder and elbow, joint arthroplasty, sports orthopaedics, spine surgery, orthopaedic trauma, foot and ankle, and pediatrics. Each chapter includes symptoms and signs, surgical pathology, diagnostic modalities, differential diagnosis, treatment options, indications for surgical intervention, step-by-step procedures, pitfalls, and prognosis.

Key Features

• Concise text and bullets provide quick procedural outlines essential for understanding procedural steps
• The generously illustrated text encompasses a full spectrum of musculoskeletal disorders related to degenerative changes, injuries, and congenital conditions
• Treatment of a variety of fractures including both bones of the forearm, Monteggia and olecranon, lateral malleolus/bimalleolar ankle, and supracondylar humeral and intramedullary fixation of forearm fractures in pediatric patients

This is an ideal, easy-to-read resource for medical students and junior residents to utilize during orthopaedic surgery rotations and for quick consultation during the early years of practice. It will also benefit allied health professionals who need a quick guide on core orthopaedic surgery procedures.

This book includes complimentary access to a digital copy on https://medone.thieme.com.

Autoren/Hrsg.

Antoci, Valentin

Eltorai, Adam

Fachgebiete

• Medizin | Veterinärmedizin Medizin | Public Health | Pharmazie | Zahnmedizin Chirurgie Orthopädie- und Unfallchirurgie

Inhaltsverzeichnis

Part I Introduction
1 Preoperative Planning and Preparation
2 Hip and Knee Arthroplasty Templating
Part II Hand Surgery
3 Open Carpal Tunnel Release
4 Trigger Finger Release
5 Open Reduction Internal Fixation of Distal Radius Fractures
6 Both Bone Forearm Fracture
Part III Shoulder and Elbow
7 Monteggia Fracture Including Olecranon Fracture
8 Distal and Diaphyseal Humerus Plating
9 Proximal Humerus Open Reduction and Internal Fixation
10 Shoulder Arthroplasty
Part IV Joint Anthroplasty
11 Posterior Approach to Hip Arthroplasty
12 Anterolateral Approach to Total Hip Arthroplasty
13 Direct Anterior Approach to Total Hip Arthroplasty
14 Component Positioning in Hip Arthroplasty
15 Total Knee Arthroplasty
Part V Sports Orthopaedics
16 Knee Arthroscopy and Meniscectomy
17 Anterior Cruciate Ligament Reconstruction
18 Shoulder Arthroscopy and Labral Repair
19 Hip Arthroscopy
Part VI Spine Surgery
20 Anterior Cervical Discectomy and Fusion (ACDF)
21 Lumbar Microdiscectomy
22 Posterior Lumbar Laminectomy and Pedicle Screw Instrumentation
Part VII Trauma
23 Antegrade Femoral Nailing
24 Retrograde Femoral Nailing
25 Tibial Nailing
26 Lateral Tibial Plateau Open Reduction Internal Fixation
27 Lateral Malleolus/Bimalleolar Ankle Fractures
Part VIII Foot and Ankle
28 Ankle Arthroscopy
29 Modified Brostrom Procedure
30 Achilles Tendon Repair
31 Hallux Valgus Surgery
Part IX Pediatrics
32 Pediatrics: Intramedullary Fixation of Midshaft Forearm Fractures
33 Supracondylar Humeral Fracture
34 Femoral Rotational Osteotomy
35 Gastrocnemius, Hamstring, and Adductor Releases/Lengthening

Leseproben

1 Preoperative Planning and Preparation

Summary

A comprehensive preoperative plan is of critical importance in determining the success or failure of a procedure. Thorough preparation with a detailed preoperative plan positively impacts the patient, surgeon, and operating room staff. A surgeon who has properly planned enters the operating room with confidence and decreased stress, allowing clear intraoperative focus. The patient benefits from a smooth and efficient operation with decreased anesthesia time and potentially less pain. The operating room staff also benefits from a sound preoperative plan by clear communication allowing equipment availability, presence of ancillary staff, and understanding the sequence of events. The AO Foundation is largely responsible for the popularity of preoperative planning in trauma surgery; however, their preoperative planning principles can be applied to any operative case.1 There are three core elements to a complete preoperative plan:

1. Identifying the desired result

2. Formation of a surgical tactic

3. Coordination of the case

preoperative plan, preoperative testing, elective procedures, medical clearance, surgical risk assessment, surgery planning, surgical tactic, case coordination, surgical timing

1.1 Desired Result

Identifying the desired result is key to identifying the necessary steps needed to achieve the outcome. Many advocate taking the time to physically illustrate the final result using radiographs, tracing paper, and implant templates. However, with the advance of digital technology, there are now many computerized templating programs, which surgeons utilize to perform this task. Illustrations allow the surgeon in identifying the best methods to solve the problem at hand. The process allows details to be worked out and intricacies identified on paper rather than in the operating room. This technique helps to develop a three-dimensional understanding of the pathology, soft tissue implications of the procedure, and ultimate strategy to arrive at the solution.

1.2 Surgical Tactic

The surgical tactic is the step-by-step rehearsal of arriving at the desired result. When drafting a surgical tactic, one must remember to record the key steps in the procedure, without cluttering the plan with trivial details. As proposed by AO,1 we recommend classifying the surgical tactic as follows:

• The patient

? Type of anesthesia (general, regional, and local)

? Need for a tourniquet

? Patient positioning (supine, prone, and lateral)

? Operating table (fracture table, flat Jackson, Jackson spine table, and radiolucent table)

? Room setup

• The procedure

? Draping

? Approach

? Operative technique

? Instrumentation and implants

? Special equipment (cell saver, electrocautery/aquamantys, etc.)

? Closure materials

? Alternative techniques

• Supportive services

? X-ray

? Product representatives

• Postoperative care

? Immobilization (splint, cast, and brace)

? Weight-bearing status

? DVT prophylaxis/antibiotics

Although this is far from an exhaustive list, it is a foundation for a detailed surgical tactic. Rehearsing the steps of the procedure mentally while classifying the steps by the patient, procedure, supportive services, and postoperative care helps to create a comprehensive plan with thorough communication.

1.3 Case Coordination

The last core element of the preoperative planning is coordination of the case to all necessary parties. The logistical details are largely covered in the surgical tactic, but thorough communication of these points to the operating room staff is critical to ensure team understanding and that necessary equipment is ready and available. The type of anesthesia, patient positioning, operating table, need for X-ray, and necessary equipment may be the most important aspects of the surgical tactic to discuss with the staff.2 Needless delays often result from poor communication of these five critical factors. Depending on the surgeon and specialty, an equipment preference list may be kept on file with the operating room, which can be referenced. However, every case is different and a preference list often falls short, illustrating the importance of the preoperative plan for each case.

1.4 Alternative Techniques

Even with a clear desired result, detailed surgical tactic, and excellent case coordination, challenges are often encountered and the plan may need to be adapted or changed intraoperatively. Having a handful of alternative techniques to arrive at the desired result is an important step of the preoperative plan that should not be overlooked. This often means communication with the operating room staff to have necessary alternative equipment clean, available, and ready outside the room in preparation.

1.5 Preoperative Testing

Preoperative testing is an essential component to a successful surgical outcome. There are many aspects of preoperative care and evaluation that must be taken into account prior to surgery. It is important to obtain a throughout history and physical examination in order to identify comorbidities and areas of potential complications. The tests that are ordered can differ depending on the type of procedure performed, whether the surgical procedure is elective, urgent or emergent, and the patient’s baseline health status. The goals of preoperative testing are to ensure medical optimization prior to the procedure to allow for the best outcome.

1.6 Elective Procedures

• Most elective procedures will require clearance from the patients’ PCP. They will evaluate the patient’s risk factors for surgery, attempt to optimize their general health status, and make referrals to pulmonology or cardiology as needed.

• If the patient has a history cardiac issues, which may include CAD, HTN, CABG, or cardiac stents, they will require a cardiologist’s clearance. This workup typically includes, but is not limited to a chest X-ray, EKG, ECHO, and stress test.

• A urine analysis is typically completed to assess for an underlying urinary tract infection, as these can be asymptomatic in elderly patients. It is important to clear any underlying infection prior to surgery to decrease the risk of postoperative complications.

• Establishing a baseline of the patient’s hemoglobin, hematocrit, and white blood cell count is important for trending changes that may occur postoperatively.

• A preoperative BMP is used to evaluate electrolytes (K+, Mg+, Ca2+) and assess kidney function (creatinine and glomerular filtration rate). These values are important when considering postoperative anticoagulation in the form of Lovenox and Coumadin.

• Assessing the patient’s ability to clot with an INR is essential in a preoperative evaluation. Certain medications and liver dysfunction can cause this value to be elevated.

• Although the value varies between surgeons, most can agree that ideally patients should have an HbA1c < 7 mg/dL. A lower HbA1c indicates better preoperative blood glucose control and a decreased risk for postoperative wound complications and infection.

• Screening for MRSA via nasal swabs is important in elective joint replacement cases. If results of the nasal swab are positive, the patient can be decolonized with mupirocin. Decolonizing patients with MRSA has been shown to decrease the risk of postoperative infection.

• It is important to review the patient’s medication list to assess if any of their medications should be held. Such medications to consider holding include: anticoagulants, antiplatelet agents, nonsteroidal antiinflammatories, antineoplastics, ACE inhibitors, diuretics, disease modifying antirheumatic drugs, TNF-a inhibitors, and selective estrogen receptor modulators. It is best practice to consult the physician prescribing the medication prior to holding a medication preoperatively.

• Discussing with the patient the importance of smoking cessation prior to surgery and postoperatively can allow for further general health optimization.

1.7 Nonelective Procedures

In situations where cases are not elective (i.e., trauma), preoperative management is based on providing medical clearance and optimization prior to proceeding with surgical intervention if the situation allows.

1.8 Timing to Surgical Intervention

• There is moderate...