Setup for an Open Reduction and Internal Fixation (ORIF) of the Tibia (South College, Knoxville, TN)

This educational video demonstrates how to set up for an open reduction and internal fixation (ORIF) of tibial fractures. A comprehensive, detailed protocol for sterile field preparation, instrument organization, and supply arrangement is outlined, emphasizing the double-draping technique, strategic placement of orthopaedic instruments, and essential safety checks. The setup also covers the preparation of power drill systems, fixation hardware, irrigation equipment, and tourniquet supplies. This video serves as a practical and easy-to-follow guide for surgical technology students, new operating room personnel, and healthcare facilities working to develop consistent and safe orthopaedic trauma protocols.

Open reduction and internal fixation (ORIF) is an important procedure for tibial fractures, which are among the most common long-bone injuries.^1–5 Proper back table setup directly influences operative time, reduces contamination risk, and minimizes intraoperative complications.⁶ Surgical technologists play a critical role in establishing the sterile environment necessary for orthopaedic trauma procedures, and must have knowledge of instrumentation, surgical workflow, and sterile technique.⁷ The goal of this video is to bridge the gap between classroom learning and real-world clinical experience.

The sterile field was established by double-draping the back table with reinforced three-quarter sheets, standard practice in orthopaedic surgery, to prevent barrier puncture from sharp instruments and maintain field integrity. The back table was separated into working and non-working ends to optimize workflow efficiency. The non-working end was designated for draping supplies, including gowns, gloves, and stockinette materials. The working end contained adhesive pads, sutures arranged by anticipated sequence, and sharps containers.

Irrigation supplies were prepared as a critical safety measure, as heat generation during drilling presents a fire hazard in oxygen-enriched environments. Both standard irrigation and pulsatile lavage systems were prepared for thermal injury prevention and wound irrigation.

Instrument trays were inspected by the circulator and surgical technologist, prior to being placed on the sterile field, to verify packaging integrity and to confirm success of the sterilization process by checking the indicators inside each tray. Instrumentation for this procedure included several types of retractors (Gelpi, Weitlaner, Bennett, Hohmann), periosteal elevators, osteotomes, bone curettes, and Freer elevators. Power drill systems underwent functional testing with battery charge verification before the start of the case. All drill bits, screws, and plates were verified (confirmed as being the correct type and size for this particular surgery).

As with all surgeries, an initial count of sponges, surgical blades, hypodermic needles, suture needles, and other sharps must be performed with a circulating nurse (circulator) or other licensed professional and documented in the patient’s record. A tibial ORIF surgery typically does not require an instrument count as a body cavity will not be entered.

A thorough back table and Mayo stand setup for tibial ORIF requires knowledge of orthopaedic instrumentation and adherence to sterile technique principles. The protocol demonstrated here supports surgical efficiency and patient safety. This video also contributes to competency development in surgical technology students and novice perioperative personnel, which can ultimately improve patient care.

This video/documentation was created for educational and training purposes. All individuals should always follow their facility’s established guidelines, policies, and protocols when performing any clinical or surgical tasks.

Please note that due to specific filming requirements and institutional requests, the surgical technologist featured was not wearing eye protection or a bouffant over her cloth cap. This deviation was made solely for filming visibility and should not be interpreted as acceptable practice. All personnel must adhere to proper personal protective equipment (PPE) protocols as outlined by their institution and governing regulatory bodies.

Additionally, individuals should maintain continuous awareness of sterile boundaries when handling instrumentation and working within the sterile field to ensure patient and personnel safety.