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Trauma, Orthopaedic and Mobile Imaging > Operating Theatre Procedures > Flashcards

Operating Theatre Procedures Flashcards

1
Q

What are some potential pelvic fractures?

A
  • Symphysis pubis dislocation
  • Pubic ramus fracture
  • Iliac fracture
  • Sacro-iliac joint dislocation
  • Sacrum fracture
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2
Q

90% of pelvis fractures will have other associated injuries which may require radiographic support in theatre. Give examples.

A
  • Retrograde urethrogram to demonstrate the urethra, bladder and ureters
  • Angiography with embolisation for arterial injuries
  • The pelvic fracture will also need to be stabilised
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3
Q

What types of hip fracture are there?

A

INTRACAPSULAR

  • femoral head #
  • subcapital #
  • femoral neck #
      • transcervical #
      • basicervical #

EXTRACAPSULAR

  • intertrochanteric #
  • subtrochanteric #
  • shaft #
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4
Q

How does a femoral head fracture occur?

A

Normally result from high energy trauma and associated with a dislocation

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5
Q

Where can the femoral neck fracture?

A

The femoral neck lies between the femoral head and the greater trochanter.

Subcapital - at the junction between head and neck
Transcervical - mid-neck
Basicervical - base of femoral neck

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6
Q

What are inter- and sub-trochanteric fractures?

A

Intertrochanteric fractures are between the greater and lesser trochanters, and subtrochanteric fractures are within 5cm distally of the lesser trochanter. Intertrochanteric fractures may also extend into the shaft, therefore having a “subtrochanteric extension”.

—> Intertrochanteric fractures are the most common hip fracture

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7
Q

What is a dynamic hip screw?

A

Most common procedure for repairing an intertrochanteric fracture.

  • Control AP + lateral taken to reduce fracture
  • Guide wire is inserted and then repositioned using AP and lateral screening
  • Dynamic hip screw is then positioned and secured with plate with screws in femur
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8
Q

What is a cannulated hip screw?

A

Used to repair femoral neck fractures. Cannulated hip screws (or AO screws are positioned through the greater trochanter to femoral neck and head.

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9
Q

What is arthrography?

A

Radiological examination for the demonstration of the soft tissue structures in joints following the injection of contrast media +/- air

  • Demonstrates menisci, ligaments, tendons, articular cartilage and bursae
  • Most common joints:
      • Shoulder
      • Knee
      • Hip
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10
Q

What are the indications for a hip arthrography?

A
  • Clicking hip
  • Dysplasia of hip joint
  • Loose hip prosthesis
  • Congenital abnormality
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11
Q

What is intermedullary femoral nailing?

A

Procedure for the repair of proximal mid-shaft fractures of the femur.

  • Bone may be realigned through external fixation
  • Reaming nail inserted in caudally from the greater trochanter
  • Proximal locking screws through greater trochanter, neck and head
  • Intermedullary nail through the cancellous bone, through the fracture and full length of the femur
  • Distal locking screws at distal end of intermedullary screw, before beginning of condyles
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12
Q

What is a LISS plat?

A

Less Invasive Stabilisation System - used for distal femoral fractures

  • Plate is measured and placed under X-ray control
  • Screws at points along length for fixation
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13
Q

How are patients positioned for a DHS?

A
  • Patient lies on table from head to bottom
  • Unaffected leg is bent in air and to one side
  • Operating leg is suspended straight out
  • Arm of affect side is suspended over chest
  • C-arm in space created by separated legs, easily able to move from AP to lateral
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14
Q

How are patients positioned for an intermedullary femoral nailing?

A
  • Patient lies on table from head to bottom
  • Both legs are suspended straight in front, with the unaffected leg also elevated
  • C-arm rests in an ‘oblique’ position between the legs
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15
Q

How do tibial plateau fractures occur?

A

Usually the result of high impact trauma.

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16
Q

How is the patient positioned for the repair of tibial plateau fractures?

A
  • Patient lies on table from head to bottom, with the table extending the full length of the leg on the unaffected side
  • Affected side is suspended at the knee over a metal frame
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17
Q

What theatre procedures for extremity trauma require radiographic support?

A
  • Manipulation Under Anaesthetic (MUA)
  • Open Reduction and Internal Fixation (ORIF)
  • Kirschner wires (K-wires)

May be done for wrist, shoulder, ankle, etc.

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18
Q

What spinal procedures require radiographic support in theatre?

A
  • Spinal decompressions
  • Spinal disectomy
  • Spinal pain relief and injections
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19
Q

How are patients positioned for spinal surgery?

A
  • Patient lies prone on table, with supports under the waist and ankles for support
  • Arm is abducted to one side
  • C-arm positioned perpendicular to table
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20
Q

What are the indications for spinal decompression?

A
  • Herniated of prolapsed intervertebral discs

* Spinal stenosis

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21
Q

What is a laminectomy?

A

The removal of the entire bony lamina, a portion of the facet joints and thickened ligaments overlying the spinal cord and nerve.

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22
Q

What is a laminotomy?

A

Removal of small portion of lamina and ligaments, usually on one side.

23
Q

What is a foraminotomy?

A

Removal of bone around the neural foramen (the space between the verterbrae where the nerve root exits the spinal canal) .

24
Q

What is a laminoplasty?

A

Expansion of the spinal canal by cutting the lamina of one side and swinging them open like a door
Only carried out in cervical spine

25
Q

What is spinal fusion?

A

A process using bone graft to allow opposing bony surfaces to grow together.

26
Q

What are the indications for spinal fusion?

A
  • Degenerative disc disease
  • Disc herniation
  • Discogenic pain
  • Spinal tumour
  • Spinal fracture
  • Scoliosis
  • Kyphosis
  • Spondylolisthesis
  • Spondylosis
  • Other degenerative conditions or conditions that cause spinal instability
27
Q

What is spondylolisthesis?

A

A condition where a vertebra slips out of position, either anteriorly or posteriorly. Most common in the lumbar spine.

28
Q

What are the types of spinal fusion?

A
  • Postero-lateral fusion
  • Interbody fusion
  • Arthrodesis
  • Spinal fixation
29
Q

What is postero-lateral fusion?

A

Places bone graft between transverse processes of spine

Vertebrae fixed in place with screws and wires through the pedicles of each vertebrae, with a metal rod on each side

30
Q

What is interbody fusion?

A

Bone graft placed between vertebrae in the area usually occupied by intervertebral disc

31
Q

What is arthrodesis?

A

Bone graft that can be taken from the patient’s pelvis

32
Q

What is spinal fixation?

A

Placement of metallic screws, rods or cages to stabilise the vertebrae

33
Q

What are the important considerations for treating spinal trauma?

A
  • Requires immediate treatment at the site of injury to prevent further injury to the spinal cord
  • Initial immobilisation of the head and whole spine
  • Steroids given to control swelling
  • Surgery to evaluate the state of the spinal cord, to stabilise any fractured vertebrae and to release pressure from the injured area
34
Q

What complex spinal conditions might spinal pain relief be given for?

A
  • Annular tear
  • Disc prolapse
  • Spinal stenosis
  • Foraminal stenosis
  • Spondylolisthesis
35
Q

What spinal pain relief procedures are there?

A
  • Nerve root blocks
  • Facet joint injections
  • Discography
36
Q

How are nerve root blocks performed?

A
  • Procedure under sedation
  • Contrast media may be used to check location of needle
  • Steroid injected into nerve root
37
Q

How are facet joint injections performed?

A
  • Under sedation
  • Injection of steroid anti-inflammatory medication which can anaesthetise the facet joint and block the pain
  • May use contrast media to check position of facet joint
38
Q

How is discography performed?

A
  • Procedure deliberately provokes the patient’s pain symptoms in order to pin point the source and level of the pain they are experiencing
  • Contrast media injected into intervertebral discs
  • Creates a pain road map which can be used for surgery planning
  • Steroid can also be injected at end of procedure to settle pain
39
Q

What is a ureteroscopy?

A
  • An optical device is passed in a retrograde fashion through the urethra and the bladder
  • The device passes directly into the ureter to inspect the lumen
  • The examination can be performed with either a flexible or rigid fibre optic device
  • A retrograde pyelogram may also be performed
40
Q

What are the indications for ureteroscopy?

A
  • Kidney and/or ureteric stones
  • Ca kidney or ureter
  • Ureteric stricture or narrowing
  • Balloon dilatations of the ureter
  • Insertion of ureteric stents
  • Trauma to ureter
41
Q

What occurs during a ureteroscopy and retrograde pyelogram?

A
  • Guide wire inserted under fluoroscopic control
  • Ureteric catheter placed over guide wire
  • Guide wire removed
  • Contrast media injected (retrograde pyelogram)
      • identifies any stones blocking ureter
  • Stones can be removed by ultrasound, laser or basket removal
42
Q

What is a percutaneous nephrolithotomy (PCNL)?

A
  • This procedure uses a needle through the skin percutaneously
  • Needle travels directly into the kidney
  • Used to either remove a stone – lithotomy
  • Or break up the stone – lithotripsy
  • Normally used for large stones, e.g. staghorn calculi
43
Q

How is a PCNL prepared?

A
  • A ureteric stent is inserted to enable blue dye to be injected into the kidney so that the radiologist/surgeon can check the exact position when they enter the kidney percutaneously
  • The patient is in a prone semi-recumbent position
44
Q

How is a PCNL performed?

A
  • Cannula is place percutaneously into the kidney
  • A guide wire is inserted down the kidney
  • A small incision is made in the patient’s back and a tract is made into the kidney using dilators
  • The final dilator is left in situ
  • Through the tract a fibre optic telescope is placed in to either remove or break up the stone into small pieces using laser, ultrasound or a pneumatic device
  • A nephrostomy tube will be placed post procedure to allow the kidney to drain and to heal
45
Q

What is a dilatation?

A
  • An enlargement made in a body aperture or canal for surgical or medical treatment
  • Restoration to normal patency of an abnormally small body opening or passageway e.g. the anus or oesophagus
46
Q

What conditions require dilatation?

A
  • Achalasia
  • Ca oesophagus
  • Post oesophagectomy
  • Stricture post bariatric surgery
  • Peptic strictures associated with a hiatus hernia
47
Q

How is an oesophageal or gastric dilatation performed?

A
  • A guide wire is passed via endoscopy into the stomach
  • The endoscope is removed with guide wire left in situ
  • Dilators fed over guide wire down the oesophagus
  • The guide wire and dilators are removed
  • The endoscope is re-inserted to check the anatomy of the oesophagus
48
Q

What is an Endoscopic Retrograde Pancreatogram (ERCP)?

A

A radiographic examination of the pancreatic and biliary systems following intubation of the ampulla of vater by a fibre optic endoscope and the injection of contrast media

49
Q

What are the indications for an ERCP?

A
  • Pancreatitis
  • Acute cholycistitis
  • Investigation of gall stones
  • Ca - obstructive jaundice
  • Stent insertion
  • Bile leaks
  • Trauma to pancreas
50
Q

How is an ERCP performes?

A
  • Endoscope is passed down the oesophagus to the second part of the duodenum to be level with the ampulla of vater
  • Cannula is passed down the endoscope and positioned at the entrance to the ampulla of vater
  • Contrast media is injected through the cannula into the bile and pancreatic ducts
  • At this stage a decision is made as to the next form of treatment:
      • A sphincterotomy can be performed to enlarge the ampulla of vater
      • Gallstones can be removed
      • Stents can be inserted
51
Q

What is a central line used for?

A
  • Chemotherapy treatment
  • Giving antibiotics
  • Giving intravenous fluids
  • Taking blood samples
  • Feeding (nutrients)
52
Q

What is operative cholangiography?

A

The injection of contrast media directly into the ducts of the biliary tract during gall bladder surgery

53
Q

What are the indications for operative cholangiography?

A
  • To check for common bile duct stones

* To visualise the anatomy

54
Q

What are the indications for angiography in theatre?

A
  • Arterial stenosis
  • Trauma
  • After surgery
  • To insert an arterial stent
  • To undertake angioplasty
  • To undertake embolisation
  • To check anatomy
  • EVAR - Endovascular aneurysm repair (or endovascular aortic repair)

Trauma, Orthopaedic and Mobile Imaging (12 decks)

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