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General considerations

Proper patient positioning is crucial. Correct positioning permits all necessary arm and shoulder motions and allows necessary imaging in multiple planes. Errors in positioning might keep the surgeon from performing a successful operation.

Remember that the initially planned procedure may be modified. An unsuccessful closed reduction might require conversion to an open procedure. Perhaps, the initially intended fixation technique may need to be replaced by an alternative type of fixation or arthroplasty.

Preoperative planning should consider all phases of the intended and possible alternative procedures:

  • instruments and implants
  • anesthesia
  • positioning
  • draping
  • imaging
  • medications (especially preoperative intravenous antibiotics to cover typical skin bacteria)
  • aftercare
  • etc

Briefing and debriefing of the operative team before and after surgery improves the conduct of the procedure and reduces the risk of complications.

A variety of different operating tables and C-arm image intensifiers are available. They are more or less compatible, and their optimal use requires both planning and practice. The surgeon must be familiar with the equipment available in his/her operating room and ensure that both necessary positions and high-quality images can be achieved. Patients also vary, and both imaging and positioning for an intended procedure must be manageable given the size and possibly limited motion of the particular patient.