Operating Theater Setup

Abstract

The surgical treatment of proximal humeral fractures should be carefully prepared. This involves knowing the patient’s medical history, performing the appropriate preoperative instrumental examinations (X-ray, CT scan with 3D reconstruction), discussing the case with the team, and obtaining the proper informed consent. Even after adequate preoperation planning, be ready to modify the therapeutic strategy in the operating theater : in case an osteosynthesis cannot be performed, it is important to have more than one type of fixation device, as well as a partial prosthesis. The patient’s surgical position varies depending on the type of surgery (beach-chair vs supine). The team (surgeons, anesthesiologist, surgical technicians) should place itself in order to work efficiently. The surgical site must be accurately prepared, ensuring that the operating field is as aseptic as possible, and that the shoulder’s mobility is not compromised. It is important to also plan antibiotic prophylaxis (third-generation cephalosporin or vancomycin) and, if necessary, thromboprophylaxis. In addition to standard antiseptic precautions, the axilla should also be thoroughly washed before surgery. When performing an osteosynthesis, the image intensifier needs to be positioned in the correct place (contralateral to the limb undergoing the operation). Following a surgical safety checklist is fundamental in order to minimize the risk of errors.