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ratory depression — the complications that lengthen recoveries.
Tools of the trade
My surgical success requires a high-quality laparoscopic camera designed
specifically for small joints (2.7mm or smaller), 2.7mm and 3.5mm shavers, and
an arthroscopic pump with variable pressure settings. The standard 70 or
80mmHg flow delivers high levels of fluid through the small joints, which causes
swelling and impedes my ability to visualize the operative field and maneuver in
already tight spaces. I'll employ gravity in-flow or turn the pumps way down to
approximately 20mmHg to prevent the joints from becoming overdistended.
I also work with a mini C-arm that provides high-quality intraoperative imaging
from a small footprint. It keeps valuable OR space clear and lets me maneuver
freely around the patient. Surgeons need to consider a unit's X-ray power, size,
arm rotation angle, safety features and digital image storage capabilities when
selecting the model that's right for your facility.
Tourniquets are used for almost all of my hand and wrist cases. They let me
perform intricate techniques in a bloodless field, which improves the efficiency
and ultimate outcomes of the procedures. We ensure a tourniquet's cuff fits
properly around the arm of each patient, particularly on obese individuals, so
pressure is applied evenly.
Although tourniquets should be set to the lowest pressure possible to limit
blood flow, use of the devices carries risk of pressure-related complications
such as muscle damage, nerve damage, coagulation issues and edema, but the
rapid pace of upper-extremity procedures significantly minimizes these risks.
Future growth
The role of orthobiologics in fracture repair is increasing rapidly (see
"Orthobiologics Help Fractures Heal"). In addition, peripheral nerve surgery is
growing in popularity, thanks to the use of nerve allografts to replace injured or
missing nerve segments. Surgeons previously used nerve tubes, which served as
conduits through which implanted nerves grew. The newer nerve allografts avoid
U P P E R E X T R E M I T I E S
