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.

SAFETY Be 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

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

AO ORGANIZATION 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 tissues Enables locomotion

ANATOMY OF BONE Diaphysis Metaphysis Epiphysis -- growth area

BONE STRUCTURE Cancellous Bone Cortical Bone

CANCELLOUS BONE Spongy bone Metaphyseal location ¼ the mass and 10% the strength of cortical bone

CORTICAL BONE Shell around all bones Thickest in diaphyseal location Very strong

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

BONE PROPERTIES Bones contain biomechanical properties of stiffness & strength but break under very little deformation

FRACTURES Overload of bone Loss of bony continuity Loss of support Soft tissue damage Damage to blood supply

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 Oblique Spiral

TYPES OF FRACTURES Impacted Comminuted

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

BONE HEALING 2 Types: Indirect bone healing Direct bone healing

INDIRECT BONE HEALING Usual picture of bone healing Callus formation “Relative” stable fixation (some motion)

INDIRECT BONE HEALING Examples of “relative” stable fixation: Casting External fixation Intramedullary nailing

DIRECT BONE HEALING Contact healing between bones No callus Requires “absolute” stability between fracture fragments (no motion)

DIRECT BONE HEALING Absolute stability comes from compression of bone fragments Achieved with lag screws and compression 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!