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
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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!
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Power tools
Drill bits
K-wires
Long hair
Long sleeves
Loose clothing
Your partner!
REMINDERS
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Turn phones to vibrate
Restroom location
Breaks, lunch, etc.
Fill out evaluation forms
WORKSHOP OBJECTIVES
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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
AO PRINCIPLES
The guiding principles of fracture care
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Anatomic reduction of fractures
Stable fixation
Preservation of the blood supply
Early mobilization to allow full rehabilitation
AO ORGANIZATION
Four “Pillars”
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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
 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
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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!