Setup for an Open Reduction and Internal Fixation (ORIF) of the Tibia (Ivy Tech Community College, Indianapolis, IN)

Open reduction and internal fixation (ORIF) of tibial fractures is one of the most common orthopaedic trauma procedures. This video provides a comprehensive back table and Mayo stand setup for an ORIF including instrumentation arrangement, integration of fluoroscopic imaging equipment, and preparation for the initial count with a circulator or other licensed professional. This setup enhances surgical efficiency, minimizes contamination risk, and promotes patient safety.

Tibial fractures are the most common long bone injuries, with ORIF serving as the gold standard treatment for displaced or unstable fractures.^1–5 Proper back table and Mayo stand setup by the surgical technologist impacts surgical duration, infection risk, and patient outcomes.

Tibial ORIF requires fluoroscopic guidance at various stages of the procedure for accurate fracture reduction. All scrubbed personnel must wear lead aprons beneath their sterile gowns for protection from radiation. Lead garments should be donned before the surgical scrub and worn throughout the case, following ALARA principles (As Low As Reasonably Achievable) to minimize radiation exposure.^6,7

The back table should be organized with placement zones, establishing a "home" for each item to promote optimal surgical flow. Place gowns, gloves, towels, and drapes on one side of the back table; use the other side for instrumentation, sharps, sponges, and other supplies. A well ordered back table makes it easier to find what is needed quickly, without moving items from place to place.

Drapes should be arranged in reverse order of use. Items to be passed off after the patient is draped (suction tubing, light handle covers, etc) may be placed in the ring basin. Once the setup is complete, the initial surgical count with the circulator can begin. The initial count of  soft goods (sponges) and sharps (blades, electrocautery tips, suture, and scratch pads) should be performed before the patient enters the operating room.

Containers holding any fluids (including syringes and cups) must be labeled immediately after the fluid or medication has been received onto the sterile field. Medications, typically a local anesthetic with epinephrine and antibiotic irrigation solutions, should be positioned on the Mayo stand for easy access by the circulator.

Instruments needed for initial exposure (scalpel, forceps, retractors, scissors, a periosteal elevator, and a small rongeur for debridement) are placed on the Mayo stand. These instruments facilitate dissection of the fracture site.

The fluoroscopy unit requires sterile draping with a snap cover, keeping hands inside during application to maintain sterility. Power equipment, particularly battery-operated drills, should have batteries attached immediately before use—not before—to preserve the charge. Brief functional testing before drilling confirms proper operation.

Manufacturer representative trays contain specialized reduction and fixation instruments such as reduction clamps and depth gauges, and screwdrivers matched to particular implant systems may be needed.

Double gloving is standard in orthopaedic procedures due to the increased risk of glove perforation from handling bone tissue, sharp instruments, and power tools. Any identified glove breach requires immediate replacement.

This standardized approach to tibial ORIF setup has many benefits. For patients, proper OR preparation reduces the risk of surgical site infection, minimizes anesthesia duration, and improves overall safety outcomes.

For surgical teams, standardized protocols enhance communication, reduce cognitive load during complex procedures, and support efficient workflow. For healthcare institutions, consistent perioperative practices contribute to quality metrics, regulatory compliance, and cost-effectiveness through reduced surgical time and complication rates.

Although facilities may have different surgical setup preferences and protocols, the fundamental principles of sterile technique, logical organization, and patient-centered care remain universal. Mastery of these core principles enables successful adaptation across diverse clinical environments.

Nothing to disclose.