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. The guiding principles of fracture care
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. 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 Metaphysis 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!