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Objectives
Assess the anatomy, physiology, and pathophysiology of the ORIF Femur. Analyze the diagnostic and surgical interventions for a patient undergoing an ORIF Femur. Plan the intraoperative course for a patient undergoing ORIF Femur. Assemble supplies, equipment, and instrumentation needed for the procedure.
Objectives
Choose the appropriate patient position Identify the incision used for the procedure Analyze the procedural steps for ORIF Femur. Describe the care of the specimen Discuss the postoperative considerations for a patient undergoing ORIF Femur .
Definition/Purpose of Procedure
Realignment and fixation of a fracture of the femur through an operative incision Goal: solid union of bone in perfect alignment, to return joints and muscles to normal position, to prevent or repair vascular trauma, and to rehabilitate the pt as early as possible
Relevant A & P
Pathophysiology
Classifications of fractures
Traumatic
Closed (Simple) Open (Compound)
Pathologic
Fractures Overview
Methods of Treatment: Closed reduction w/immobilization Skeletal traction External fixation Internal fixation Electrostimulation
Internal Fixation
Overview Screws, Plates, Nails Intermedullary nailing
Advantages: increase and evenly spread load sharing of the bone, reduced scarring, minimal blood loss, low infection rate, fracture hematoma preserved at fracture site. Type of nail
Fixation of a short oblique fracture using a plate and screws above and below the fracture
Fixation of a long oblique fracture using screws through the fracture site
Diagnostics
Exams
X-ray
Preoperative Testing
Etc
Have x-rays in room Some surgeons prefer to double-glove and remove the first pair following completion of draping Observe x-ray precautions; notify radiology dept when pt is being positioned for preliminary films; intraop xray will be used (either via portable machine or C-Arm flouroscopic image intensification) Wear protective goggles
Order of draping
Four sheets may be draped around perimeter of site;
Specific
Sterile plastic adhesive U-drapes (2) (perineum and operative site) Suture & Blades: Blades (2) # 10 Medications on field (name & purpose) Catheters & Drains
Specific
AO femoral nail instrumentation set Hip retractor tray Bone holding instruments tray Drill bits, including gauge Power reamer and drill and cords, long guide wires, Extra guide pins, screw set Fixation device: Rods or nails (eg. Hanson-Street, Kuntscher, Rush) or compression set and instrumentation particular to that device
Kuntschner Nail
Specific
Fracture Table or leg holder (optional)
The STSR loads the 4.0-mm calibrated drill bit onto the power drill and hands it to the surgeon, who drills thru both cortices until the drill
sleeve presses against the cortex. The locking bolt length is read from the calibrated drill and communicated by the surgeon to the STSR.
Counts
Initial: Sponges and sharps First closing Final closing
Sponges Sharps
Postoperative Care
Destination
PACU
Postoperative Care
Potential complications
Hemorrhage Infection Other: Damage to.
Surgical wound classification: Class I, unless traumatic injury with visible debris--
Resources
Alexanders pp. 880-882 Berry & Kohn p. 751- 755 Goldman pp. 330-332 Lemone & Burke pp. 1193-1203 MAVCC Info Sheets Unit 10 STST pp. 851-853.
Cast Application
Supplies and equipment Types Technique
Casting Supplies
Plaster of Paris or fiberglass cast material Webril and soft roll as needed Bucket and water to requested temperature Clean gloves Cast cutter, spreaders, heavy bandage scissors on standby