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 Certificates distributed

after consultant returns documents to Nursing CE office

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

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.

SAFETYBe Careful!

Power tools Drill bits K-wires Long hair Long sleeves Loose clothing Your partner!

REMINDERS

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

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

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

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

AO PRINCIPLESThe guiding principles of fracture careThe guiding principles of fracture care

Anatomic reduction of fractures Stable fixation Preservation of the blood supply Early mobilization to allow full rehabilitation

AO ORGANIZATION

Four “Pillars”Four “Pillars”

Documentation Research Teaching Instrumentation

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

TEACHING & EDUCATION Another one of the “pillars”

AO Courses:

Surgeons

Residents

Veterinarians

Operating Room Personnel

Workshops such as this workshop More than an “inservice”

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

BONE -- A LIVING TISSUE

Supports soft tissuesSupports soft tissues Enables locomotionEnables locomotion

DiaphysisDiaphysis

MetaphysisMetaphysis

Epiphysis -- Epiphysis -- growth areagrowth area

ANATOMY OF BONE

BONE STRUCTURE

Cancellous BoneCancellous Bone

Cortical BoneCortical Bone

CANCELLOUS BONE

Spongy boneSpongy bone Metaphyseal locationMetaphyseal location ¼ the mass and 10% ¼ the mass and 10%

the strength of cortical the strength of cortical bonebone

CORTICAL BONE

Shell around all bonesShell around all bones Thickest in diaphyseal Thickest in diaphyseal

locationlocation Very strongVery strong

DiaphysisDiaphysis Nutrient artery, 2/3 of blood Nutrient artery, 2/3 of blood

supplysupply Periosteal vessels, 1/3 of blood Periosteal vessels, 1/3 of blood

supplysupply

MetaphysisMetaphysis Rich blood supplyRich blood supply Endosteal vessels, periosteal Endosteal vessels, periosteal

vessels and soft tissuesvessels and soft tissues

BLOOD SUPPLY

BONE PROPERTIES

Bones contain biomechanical properties of Bones contain biomechanical properties of stiffness & strength but break under very little stiffness & strength but break under very little deformationdeformation

FRACTURES

Overload of boneOverload of bone Loss of bony continuityLoss of bony continuity Loss of supportLoss of support Soft tissue damageSoft tissue damage Damage to blood Damage to blood

supplysupply

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

TYPES OF FRACTURES

Transverse

ObliqueSpiral

TYPES OF FRACTURES

Impacted

Comminuted

BONE HEALING

How bone heals depends on the How bone heals depends on the stability of the fracture fixation and the stability of the fracture fixation and the motion between the fragmentsmotion between the fragments

Relative stability – some motionRelative stability – some motion Absolute stability – no motionAbsolute stability – no motion

BONE HEALING

2 Types:2 Types: Indirect bone healingIndirect bone healing Direct bone healingDirect bone healing

INDIRECT BONE HEALING

Usual picture of bone Usual picture of bone healing healing

Callus formationCallus formation ““Relative” stable fixation Relative” stable fixation

(some motion)(some motion)

INDIRECT BONE HEALING

Examples of “relative” stable fixation:Examples of “relative” stable fixation: CastingCasting External fixationExternal fixation Intramedullary nailingIntramedullary nailing

DIRECT BONE HEALING

Contact healing between Contact healing between bonesbones

No callusNo callus Requires “absolute” Requires “absolute”

stability between fracture stability between fracture fragments (no motion) fragments (no motion)

DIRECT BONE HEALING

Absolute stability Absolute stability comes from comes from compression of bone compression of bone fragmentsfragments

Achieved with lag Achieved with lag screws and screws and compression platescompression plates

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

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

FRACTURES

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

fractures

FRACTURES

Which MAY be operated on: Tibia shaft fractures Humeral shaft fractures

FRACTURES

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

PREREQUISITES FOR SURGICAL CARE

Proper operating room environment

Trained surgeon Trained personnel Appropriate instruments

and implants Adequate aftercare TEAMWORK!

GOALS TODAY

Learn AO fracture techniques Learn use of instrumentation Become a more knowledgeable

member of the OR Team Have fun!