Working in Theatre and ORIF Surgery

A scan of a Weber's Category B fracture.

Stardate: 91665.06

Day three of my placement, and luckily once again I was in theatre, and I have to say I'm really enjoying it. I saw one spinal examination today on the lumbar spine, and an ORIF (Open Reduction and Internal Fixation) surgery on an ankle.

The spinal examination required little screening, and these were few and far between, which meant half of the time was spent not being able to see anything and standing around waiting to be needed. 

This led me to think of what a student radiographer needs to know before going into theatre. My general thoughts were just tips on how to feel less overwhelmed by theatre situations, as it is a whole new environment:

• know the theatre rules and the theatre culture
• make sure you're wearing the right personal protection equipment - e.g. hat, mask, lead-rubber aprons
• once the patient's skin is open, assume everything is sterile - don't touch anything except the radiography equipment and you'll be okay!
• know how to use the image intensifier (C-arm - a portable C-shaped x-ray device used for imaging during surgical procedures), or observe it being used before undertaking it yourself
• know what is needed during the procedure, if unsure, ask your supervisor
• go to the toilet before surgery - you can be in there for a really long time!
• and if you feel faint, back up to the wall and slide to the floor

The second case was one I attended almost fully unassisted by my supervisor. I felt confident enough to handle the C-arm by myself, and the only hindrance I faced was the positioning of the patient on the table, as they were a little lower down than normal, which meant a bit of the table's metal framework was unavoidably in the image, but not obscuring it. This case was the ORIF ankle case. Open Reduction is surgery to set bones, and Internal Fixation is the fixing of screws and/or plates to facilitate healing. This surgery is used when casting or splinting a fracture alone would not assist repair.

This went well and I was quite impressed at my being pro-active with getting the imaging done and feeling that I could do the examination. The patient had a Weber's fracture (ankle fracture) on the medial malleolus (inner side) of the ankle, and the plates were being placed so the bone was able to heal correctly. I was given positive feedback, and I think I'm much more confident than I was before on placement, and I'm starting to get into the hang of working within different departments.

I think this has been my favourite week so far! Now to do a quick workout, eat a cookie and watch 'An Idiot Abroad' in bed!

LLAP!

References

1. Jeremy Jones, Radiopedia.org, photograph, viewed 22 January 2014 <http://images.radiopaedia.org/images/341127/186015a2d8111ae7f0232b0fb61ab9.jpg>.