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The time management of bone plate fixation surgery runs through the three stages of preoperative, intraoperative and postoperative, which is crucial for the surgical outcome and the prognosis of patients. The following is a detailed introduction:
Preoperative time management
Precise assessment and planning
Comprehensive examination: After the patient is admitted to the hospital, relevant examinations should be arranged as soon as possible, such as blood routine, coagulation function, liver and kidney function and other blood tests, as well as X-ray, CT, MRI and other imaging examinations. These examinations can provide a basis for doctors to accurately determine the condition of fractures and formulate surgical plans. Generally speaking, basic blood tests such as blood routine and coagulation function can yield results on the same day, while imaging tests may take 1 to 2 days. Doctors should arrange the sequence and time of the tests reasonably to avoid delays.
Multidisciplinary consultation: For patients with complex fractures or other underlying diseases, multidisciplinary consultations should be organized, such as those from orthopedics, anesthesiology, cardiology, etc. The consultation time should be arranged as early as possible to ensure that the overall condition of the patient and the surgical risks are clearly understood before the operation, and a personalized treatment plan is formulated. The consultation is usually completed within 1 to 2 days after the patient’s admission.
Surgical plan formulation: Based on the examination results and consultation opinions, the doctor formulates a detailed surgical plan, including the selection of bone plates, surgical approaches, fixation methods, etc. This process requires doctors to comprehensively consider multiple factors and usually takes 1 to 2 days. Meanwhile, it is necessary to fully explain the surgical plan, risks and prognosis to the patients and their families and obtain their consent. This may take half a day to a day for communication.
Preoperative preparation
Patient preparation: Guide the patient to fast and abstain from water before the operation. Generally, adults should fast for 8 to 12 hours and abstain from water for 4 to 6 hours before the operation to prevent dangers such as vomiting and aspiration during anesthesia. Psychological counseling should also be provided to the patients to relieve their tension. These preparations are usually completed one day before the operation.
Preparation of surgical instruments and items: Operating room nurses need to prepare corresponding surgical instruments and items such as bone plates, screws, electric drills, and periosteal strippers according to the surgical plan, and conduct strict disinfection and inspection to ensure that the instruments are in good performance and in sufficient quantity. This process is usually completed the day before the operation to ensure a smooth operation on the day of the operation.
Intraoperative time management
Anesthesia induction and monitoring
Anesthesia induction: Anesthesiologists select appropriate anesthesia methods based on the patient’s physical condition and surgical requirements, such as general anesthesia and intraspinal anesthesia. The process of anesthesia induction should be rapid and smooth, minimizing the impact on the patient’s circulatory and respiratory systems as much as possible. Generally speaking, the induction time for general anesthesia is about 5 to 10 minutes, while that for intraspinal anesthesia is slightly longer, approximately 10 to 15 minutes.
Anesthesia monitoring: During the surgical procedure, anesthesiologists need to closely monitor the patient’s vital signs, such as heart rate, blood pressure, respiration, and blood oxygen saturation, and promptly adjust the depth of anesthesia and dosage of medication to ensure the patient’s life safety. Anesthesia monitoring runs through the entire surgical process and is an important link of intraoperative time management.
Surgical operation
Incision exposure: The surgeon cuts open the skin, subcutaneous tissue and muscle along the prearranged surgical approach to expose the fracture site. This process should minimize damage to the surrounding tissues as much as possible, and the movements should be gentle and accurate. The exposure time of the incision depends on the location and complexity of the fracture. Generally, the exposure time of the incision for simple fractures is about 10 to 20 minutes, while for complex fractures, it may take 30 minutes or even longer.
Fracture reduction and fixation: This is a crucial step in the surgery. The doctor needs to reduce the fracture ends to the normal anatomical position and then fix them with bone plates and screws. The reduction and fixation process requires doctors to have proficient surgical skills and rich experience to ensure the stability and effectiveness of the fixation. The reduction time is generally about 15 to 30 minutes. The fixation time varies depending on the type of fracture and the number of bone plates, and may take 30 to 60 minutes.
Wound suturing: After the fracture fixation is completed, the doctor needs to thoroughly rinse the wound and stop the bleeding, and then suture the wound layer by layer. Wound suturing should be meticulous to avoid postoperative complications such as wound dehiscence and infection. The time for wound suturing is usually about 15 to 30 minutes.
Postoperative time management
Anesthesia recovery
Recovery observation: After the operation, the patient will be sent to the anesthesia recovery room for recovery observation. Anesthesiologists need to closely monitor the vital signs and state of consciousness of patients to ensure their safe awakening. The recovery time depends on the duration of action of the anesthetic drug and the patient’s physical condition. Generally, the recovery time of patients under general anesthesia is about 30 minutes to 2 hours, while that of patients under intraspinal anesthesia is relatively shorter, approximately 15 to 30 minutes.
Removal of the tracheal tube: When the patient regains consciousness, breathing is stable, and blood oxygen saturation returns to normal, the anesthesiologist will remove the tracheal tube. The extubation process should be operated with caution to avoid adverse reactions such as choking cough and laryngeal spasm in the patient.
Postoperative monitoring and care
Ward monitoring: After the patient returns to the ward, the nurse should closely observe the patient’s vital signs, wound condition, limb sensation and motor function, etc. Generally, within the first 6 hours after the operation, vital signs should be measured every 15 to 30 minutes. After that, the measurement interval should be appropriately extended according to the patient’s condition.
Pain management: Postoperative pain can affect a patient’s rest and recovery. Nurses should promptly assess the patient’s pain level and prescribe appropriate pain-relieving medications as per the doctor’s advice. Pain assessment and administration time should be carried out in a timely manner according to the patient’s pain condition to ensure that the patient’s pain is effectively controlled.
Rehabilitation guidance: After the patient’s condition stabilizes, doctors and nurses should provide rehabilitation guidance to the patient as soon as possible, including methods, time and precautions for limb function exercises, etc. Rehabilitation guidance should be progressive and the exercise plan should be adjusted in a timely manner according to the patient’s recovery situation. Generally speaking, simple isometric muscle contraction exercises can be started on the first to second day after the operation. Within the first to second week after the operation, joint range of motion training can be gradually increased according to the situation.