Background
The use of a bolster in orthopaedic surgery is commonplace for cases such as retrograde nailing of the femur, antegrade nailing of the tibia or tibial plateau fracture fixation. An oft-used technique is to insert a non-sterile block into a sterile Mayo stand cover. Contamination of the outer surfaces is easier than expected. Rolling back the edges of the cover before inserting the bolster means only the internal surface of the Mayo cover should be contaminated. However, to roll the edge back and secure it without contaminating the surgeon’s gloves and the bolster is difficult. Our simple method eliminates this breach in sterility.
Technique
A pack of sheet-type incontinence pads makes a cheap, padded block, the size of which can be altered to fit the patient by adding or removing pads (a large sharps bucket can also be used for tibial nailing). Two image intensification covers are used to cover the pack. The first is put over the pack on a non-sterile surface (Figs 1 and 2). The pack is inverted and placed sterile side down on a sterile Mayo stand (Fig 3) The opposing image intensifier cover is then applied overlapping the first (Fig 4) and the pack inserted into a sterile Mayo stand cover (Fig 5). Air is eliminated and the cover folded back on itself and sealed with adhesive tape (Figs 6 and 7).
Figure 1.
A pack of incontinence pads (the bolster) is placed on a non-sterile Mayo stand and an image intensifier cover is placed over the top half.
Figure 2.
The sterile image intensification cover allows the bolster to be handled.
Figure 3.
The bolster is placed sterile side down on a sterile, covered Mayo stand.
Figure 4.
A second sterile image intensifier cover is now used to completely enclose the bolster.
Figure 5.
The completely enclosed bolster is transferred into a sterile Mayo stand cover without risk of contaminating the edges. The cover is then rolled around the bolster, sealing off the interior.
Figure 6.
The rolled Mayo stand cover is secured with adhesive operating tape, creating a seal.
Figure 7.
The completed bolster, with an uncontaminated surface and a happy surgeon!
Discussion
Any risk of introducing contaminants to the operative field in the process is minimised by this simple step of using sterile image intensification covers.
Video Link https://www.youtube.com/watch?v=ZvVlSMqQoMc&feature=youtu.be