WELCOME

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!