To achieve the best possible outcomes in orthopedics, surgeons need room to move and precise views of the surgical field. Staff members must handle the physical demands associated with supporting patients and helping to keep limbs stable. And patients need to be protected from infection, neurologic injury and skin breakdown.
With all those considerations to manage, the best and most versatile tables and attachments don’t just facilitate a wide variety of procedures. They also allow for precise positioning, help reduce the need for manpower in the OR, and feature designs and materials that help protect patients from complications.
Concerns about patient safety have led to a significant number of recent advances. Manufacturers, working with providers, have pinpointed deficiencies in older hardware and made welcome changes that help reduce infections and other negative outcomes.
You don’t need a lot of attachments to be able to handle just about any body part. A few basics will let you perform a diverse set of services:
- Knee and limb positioners. A few companies now offer an important innovation: Single-use padded and sterile devices that attach to the table after the patient is draped for the procedure. The positioner attaches to a metal base plate and applies traction through the lower extremity, holding the knee in a flexed position at about 45 degrees. That allows improved exposure at the joint level and applies a consistent level of distraction that no one trying to hold the leg in that position would be able to maintain for very long.
Additionally, instead of locking the extremity into one set position for the entire procedure, which makes initial positioning even more critical, the new devices let you change positions during procedures without compromising sterility. Newer attachments are also ideal for rotator cuffs and wrists because they let you reposition the limb by stepping on a foot pedal, instead of having a staff member hold it throughout the surgery.
We’re also seeing movement away from pressurized lines that plug into wall sockets and run across the floor, adding to the potential tripping hazards that already exist in ORs. Some positioners come with rechargeable batteries and don’t require an OR setting for air pressure. That also decreases the chance of breaking the sterile field.
- Clark Sockets let you attach and lock accessories along a table’s side rails, enabling the use of arm holders and elbow devices. Some newer versions even rotate 360 degrees, making setups faster and easier.
- Candy cane or boot stirrups keep feet and legs secure when patients are in the lithotomy position.
- Foot and head extensions are critical for fracture work that involves positioning patients for X-rays.
- Shoulder positioners help stabilize patients in the “beach chair” position for improved joint access.
- Radiolucent arm tables for upper extremity surgery can be attached to the topside rails.
As time goes on, we’re also seeing more and devices that are designed to accommodate a wide range of body parts, which is very helpful. Along with that versatility, the primary goals continue to be safety and reducing the need for manpower. Over time, you’ll save money if you can reduce the number of people who have to be in the room at any given time.
In addition to attachments, the quality of table pads has improved dramatically. Tables now come with softer gel surfaces that help reduce the skin breakdown and neurologic injuries that can occur during longer procedures.
That’s also a big concern as we deal with the challenges associated with operating on heavier patients: As body-mass indexes climb, so do the risks of infection and nerve damage. Softer and better padding also helps protect extremely frail patients — such as the elderly — who tend to have a higher likelihood of skin breakdown around bony prominences.
Heavier patients are also forcing table manufacturers to up the weight capacities of their offerings. Traditionally, a lot of beds have been built with a 300-pound capacity. These days we routinely run up to that limit and beyond. And manufacturers are responding, now touting tables that can handle 500-, 600-, even 700-pound patients.
Improvements in padding have also made it easier to sterilize tables between cases, which saves time and decreases the likelihood that contaminants from a previous case will infect subsequent patients. That’s a big step forward.
Where do we go from here? What improvements can be made? One of the limitations I frequently run into is the inability to X-ray patients during procedures. There are times you can’t get the view you’d like because most apparatuses are made of metal, which you obviously can’t X-ray through. Making attachments out of more radiolucent materials, such as carbon fiber, would improve procedures by allowing for easier imaging.
Some manufacturers have started doing that, but the radiolucent attachments haven’t gained widespread use yet, I imagine because of the cost. Figuring out a way to put improved radiolucency within everyone’s reach may be the next step forward for precision and added safety.