Davos Courses

Executive Editor: James Hunter General Editor: Fergal Monsell

Authors: Andrew Howard, Peter Schmittenbecher, Theddy Slongo

Pediatric proximal forearm

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Glossary

Prone position

Preoperative preparation

The following are essential for successful surgery:

  • Patient information
  • Operating room personnel (ORP) information/instruction
  • Surgical planning

Patient information

Before treatment discuss the following information with the patient/parents/carers:

  • Nature of the injury
  • The chosen treatment and why a particular treatment is selected
  • Alternative treatments
  • General operative risks
  • Expected healing time
  • Functional recovery
  • Implant removal

Information for operating room personnel

Operating room personnel (ORP) need to know and confirm:

  • Consent form, completed and signed
  • Site and side of fracture
  • Type of operation planned
  • Surgical approach
  • Operative site has been marked by the surgeon
  • Condition of soft tissues
  • Equipment/implants needed
  • Patient positioning
  • Duration of operation
  • Positioning of image intensifier
  • Antibiotic prophylaxis
  • Comorbidities, including allergies

Surgical planning

The surgeon should make sure that:

  • Relevant x-rays and other images are available in the OR.
  • Required instruments and implants are accessible and ready.
  • Tourniquet is available (a sterile tourniquet makes draping more straightforward).
  • Image intensification is available.
  • Intraoperative x-ray documentation should be undertaken, with clear AP and lateral views, before applying any plaster cast.
  • There is a clear, step-by-step plan of the operation, including backup plans.

Anesthesia

  • General anesthesia
  • Local nerve block
  • Combination of nerve block and light general anesthesia
  • Prophylactic antibiotics (see local microbiological protocols.)

Prone position enlarge

Patient positioning

Position the patient prone with the forearm hanging free supported with a bolster under the distal humerus.


Prone position - C-arm positioning enlarge

C-arm positioning

Position the C-arm parallel to the operating table.

For AP view extend the elbow.


Prone position - C-arm positioning enlarge

For lateral view rotate the C-arm, not the forearm.


Prone position - Skin disinfecting and draping enlarge

Skin disinfecting and draping

With an assistant holding the arm, disinfect the entire arm down to the fingertips.

Drape the hand in a glove or leave it free.

Drape the arm up to the shoulder.


Prone position - OR set-up enlarge

OR set-up

The optimal position of the surgeon is perpendicular to the operating table in front of the elbow.

The position of the screen should allow a direct view for the surgeon.

The position of operating room personnel should permit ergonomic assistance.

v1.0 2019-08-19