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Setup · CardiacCreated by our team

Modified Distal Facial Exploration

Laparoscopic paraesophageal hernia (PEH) repair · laparoscopic esophageal hiatal herniorrhaphy · esophageal hernia repair with

In a child with one working ventricle.

10 steps · 70 instruments

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Position
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Anesthesia
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Specimen
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Wound class
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In 30 seconds

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The case in 30 seconds

The whole case in a few lines, to scan outside the room.

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Where new techs slip
Where new techs slip

The mistakes the books warn about on this case, and how to stay ahead of each.

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The tray

70 instruments, by what they do. Tap a name for its card.

The tray: 70 instruments

Every instrument on the back table for this case, each with its photo and what it is for.

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Exam prep for this setup

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A timed examTarget 41:40Pro

The room

The equipment, the prep and drape, the suture and the medicines.

The room

The equipment in the room for this case, how the patient is prepped and draped, the suture and the medicines.

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Step by step

10 steps, one line each.

10-step walkthrough

The case from start to finish, with what to have ready next at every step.

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If it goes wrong

What to grab, before anyone asks.

If it goes wrong

What to grab for this case if it bleeds, spills or has to be opened.

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About the procedure

The case

The fibula is the thin bone on the outer side of the lower leg. Its lower end forms the bump on the outside of the ankle (the lateral malleolus) and makes up one side of the ankle joint's socket. When the broken ends have shifted, the ankle bone can slide out of place, so the fibula is fixed to keep the ankle stable and to lower the chance of arthritis later.

In an open reduction internal fixation (ORIF), the surgeon makes a cut along the outer side of the leg, lines the broken bone back up, and holds it with a thin metal plate and screws on the bone. A slanted break may also get one or two screws straight across it. Live x-rays guide each step. Metal screws occasionally have to come out later. When the inner ankle bone or the back of the shinbone is broken too, those are fixed in the same operation.

The operation is done under general anesthesia or a regional block, with a tourniquet on the thigh. Afterward the ankle rests in a splint or a cast while the bone heals.

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