Before a surgical procedure, the most exigent thing is time which a surgeon gives to a cautious pre-operative plan and usually it ascertains the success or failure of the procedure. The surgeon can take the required time to define the surgical problem, to identify thoroughly all the anatomical and technical details of the procedures, and then plan the solution meticulously. After the surgery external fixator required for the fixations.
To define the surgical problem, first, the surgeon must initiate the diagnosis. This needs a complete history, a careful physical examination, all essential laboratory tests, proper x-rays and the needed ancillary imaging studies like 3-D reconstruction, CT scans or MRI whatever the clinical condition requires.
Only diagnosis is not sufficient to guide a surgeon to choose the correct procedure for surgery. Considering the patient’s physical condition and his/her expectations of the recommended treatment, proper decision must be taken. Furthermore, the knowledge of the pertinent operative procedure is essential for a surgeon. He must be aware of risks and success rate as well. If feasible, all the benefits and risks should be made clear to the patient. Then, the decision to operate and the choice of the procedure must be made. Failure of preparing a detailed pre-operative plan originates from the lack of proper communication with the patient.
A careful pre-operative plan’s main feature is to identify the expected result and then prepend a comprehensive list of all the surgical steps included in the course of action.
There are several benefits of careful pre-operative planning and the simple requirements are:
- Fine quality x-rays, including view of normal side when relevant and possible.
- A goniometer
- A complete set of required implant templates of accurate scale.
- Good tracing paper or transparencies
- Pens with coloured felt-tipped and a sharp pencil.
A surgeon can reach out the best method or methods of solving a problem by using drawings. The planning of a surgical procedure is carried out on paper. It can be repeated if needed until the surgeon apprehend the complete dimension and enormity of the problem and finds the best solution. This process of trial and error helps the surgeon to know the variability and complexity of the problem to be solved. The expertise to shift the tracing around, to overly one on the other, to expand, to shorten, to replace or angulate, all aid id developing a 3-D image of the problem, of its related soft-tissue implications, and of the final solution.
Then, the surgeon is to locate important marks for implant insertion, and measure all the angles, distances, and sizes of segments which leads to selection of implant and its appropriate size. The surgeon will never start the operation if lacking the required implants and tools. The surgeon will never try an inapt approach on an improperly positioned patient. The graphically represented plan forms a permanent record of the thought process and of the solution of the problem. If accurately executed, in due course, it should be seen to correspond to the post-operative x-ray, letting an instant quality control of the surgeon’s efforts.
All the necessary steps and their order, in which they are to be executed, should be mentioned in the plan. This provides a lay out to the operation and allows the surgeon to focus on the procedure without making it improvisatory at each stage. It removes all the distractions and makes the surgery not only faster but safer also. However, unpredicted, or unforeseen conditions can or do occur during the surgical procedure, and the surgeon is expected to be ready all the time to adapt in such conditions accordingly.
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