Anticipation (Preoperative Planning)

Abstract

Successful operative reduction and internal fixation necessitates a thorough understanding of all phases of the procedure, the approach, and the mechanics of the fracture. This goal is easier to achieve when the operation is planned beforehand. As with all major construction, which is centered on a blueprint or plan, “the drawing board” is where the problem in construction is best solved. In the orthopedic training programs of the 1960s and 1970s minimal time was devoted to preoperative planning. The major emphasis was on the indications for various procedures — intramedullary nailing, plating, etc. — and how to perform them. During this formative time, a lot of surgeons developed an intuitive sense of how the operation would actually unfold, and as a result many pride themselves on their ability to “eyeball” a correction. Although some do indeed have this talent, for the majority this approach leads to less than desirable results. The method of preoperative planning most frequently taught during this period was the use of “cutouts” made with X-ray copies. When an osteotomy was to be performed, cutouts of the X-ray were made, taped together in their new position, and the procedure planned. A problem with cutouts was that the reference, i.e., the normal side of the patient, was not considered. Cutouts also enticed the surgeon to be prematurely definitive.