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WELCOME

WELCOME. Introduction to an AO Workshop for Operating Room Personnel Indications for Internal Fixation. WORKSHOP FORMAT. Lectures Video demonstrations Hands-on practical sessions Discussion. WORKSHOP MATERIALS. Agenda Evaluation Form

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WELCOME

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  1. WELCOME Introduction to an AO Workshop for Operating Room Personnel Indications for Internal Fixation

  2. WORKSHOP FORMAT • Lectures • Video demonstrations • Hands-on practical sessions • Discussion

  3. WORKSHOP MATERIALS • Agenda • Evaluation Form • Certificates distributed after consultant returns documents to Nursing CE office

  4. ACCREDITATION • AO North America is accredited as a provider of continuing nursing education by the American Nurses Credentialing Center’s Commission on Accreditation • The activity is approved by the Association of Surgical Technologists, Inc. for continuing education credits in surgical technology • See 1st page of agenda for # of contact hours

  5. DISCLOSURE • The American Nurses Credentialing Center (ANCC) requires speakers to disclose to you any financial interest or relationship with a commercial company that manufactures products that they may discuss in their presentation(s). • The purpose of the activity is education and not the promotion or sale of a specific company’s products.

  6. SAFETY Be Careful! • Power tools • Drill bits • K-wires • Long hair • Long sleeves • Loose clothing • Your partner!

  7. REMINDERS • Turn phones to vibrate • Restroom location • Breaks, lunch, etc. • Fill out evaluation forms

  8. WORKSHOP OBJECTIVES • Review the history of the AO • Describe bone properties and fracture types • Relate how bones heal • Identify when fractures are treated surgically (also called “indications”) • Discuss specific fractures and the implants used • Practice the techniques on artificial bones

  9. WHY THE AO STARTED • High percentage of disabilities after motor vehicle and skiing accidents • Swiss dissatisfied with methods of fracture treatment in the 1940’s

  10. AO ASIF • Arbeitsgemeinschaft fur Osteosynthesfragen • Association for the Study of Internal Fixation • Founded in 1958 by small group of Swiss surgeons • Dedicated to improving the care of patients with musculoskeletal injuries AO Logo

  11. AO PRINCIPLES The guiding principles of fracture care • Anatomic reduction of fractures • Stable fixation • Preservation of the blood supply • Early mobilization to allow full rehabilitation

  12. AO ORGANIZATION Four “Pillars” • Documentation • Research • Teaching • Instrumentation

  13. INSTRUMENTATION • Instrumentation is one of the “pillars” & started in early 60’s to manufacture implants and instruments to achieve AO’s principles • SYNTHES is the commercial arm of AO • Instruments standardized worldwide

  14. TEACHING & EDUCATION • Another one of the “pillars” • AO Courses: • Surgeons • Residents • Veterinarians • Operating Room Personnel • Workshops such as this workshop • More than an “inservice”

  15. AO COURSES • Started in 1960 for surgeons & 1963 for O.R. personnel (ORP) • Early emphasis on teamwork • 1963 - 2008 • 1,965 ORP courses • 136,000 participants • More than 70 countries

  16. BONE -- A LIVING TISSUE • Supports soft tissues • Enables locomotion

  17. ANATOMY OF BONE • Diaphysis • Metaphysis • Epiphysis -- growth area

  18. BONE STRUCTURE • Cancellous Bone • Cortical Bone

  19. CANCELLOUS BONE • Spongy bone • Metaphyseal location • ¼ the mass and 10% the strength of cortical bone

  20. CORTICAL BONE • Shell around all bones • Thickest in diaphyseal location • Very strong

  21. BLOOD SUPPLY • Diaphysis • Nutrient artery, 2/3 of blood supply • Periosteal vessels, 1/3 of blood supply • Metaphysis • Rich blood supply • Endosteal vessels, periosteal vessels and soft tissues

  22. BONE PROPERTIES • Bones contain biomechanical properties of stiffness & strength but break under very little deformation

  23. FRACTURES • Overload of bone • Loss of bony continuity • Loss of support • Soft tissue damage • Damage to blood supply

  24. TYPES OF FRACTURES • Amount of force, direction of force, and soft tissue attachments determine fracture patterns: • Transverse • Oblique & Spiral • Impacted • Comminuted • Each pattern requires an implant with different biomechanical properties to resist body’s forces

  25. TYPES OF FRACTURES Transverse Oblique Spiral

  26. TYPES OF FRACTURES Impacted Comminuted

  27. BONE HEALING • How bone heals depends on the stability of the fracture fixation and the motion between the fragments • Relative stability – some motion • Absolute stability – no motion

  28. BONE HEALING • 2 Types: • Indirect bone healing • Direct bone healing

  29. INDIRECT BONE HEALING • Usual picture of bone healing • Callus formation • “Relative” stable fixation (some motion)

  30. INDIRECT BONE HEALING • Examples of “relative” stable fixation: • Casting • External fixation • Intramedullary nailing

  31. DIRECT BONE HEALING • Contact healing between bones • No callus • Requires “absolute” stability between fracture fragments (no motion)

  32. DIRECT BONE HEALING • Absolute stability comes from compression of bone fragments • Achieved with lag screws and compression plates

  33. Summary • Lag screws & compression plates provide absolute stability & direct bone healing • Casts, ex fix and IM nails provide relative stability & indirect bone healing • Both have their place in internal fixation

  34. When Should You Consider Surgery?(Indications) • Internal fixation should be used only if the disadvantages of conservative treatment can be overcome by surgical treatment • Requires knowledge of the techniques & adherence to the principles

  35. FRACTURES • Which MUST be operated on: • Open fractures • Intra-articular (in the joint) fractures

  36. FRACTURES • Which MAY be operated on: • Tibia shaft fractures • Humeral shaft fractures

  37. FRACTURES • Which should NOT be operated on: • Simple vertebral fractures • Uncomplicated clavicle fxs • Most children’s fractures

  38. PREREQUISITES FOR SURGICAL CARE • Proper operating room environment • Trained surgeon • Trained personnel • Appropriate instruments and implants • Adequate aftercare • TEAMWORK!

  39. GOALS TODAY • Learn AO fracture techniques • Learn use of instrumentation • Become a more knowledgeable member of the OR Team • Have fun!

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