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

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Presentation on theme: "WELCOME Introduction to an AO Workshop for Operating Room Personnel Indications for Internal Fixation."— Presentation transcript:

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 1 st 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   1,965 ORP courses  136,000 participants  More than 70 countries

16 BONE -- A LIVING TISSUE  Supports soft tissues  Enables locomotion

17  Diaphysis  Metaphysis  Epiphysis -- growth area ANATOMY OF BONE

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  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 BLOOD SUPPLY

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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