1.1 Desired Result

Identifying the desired result is key to identifying the necessary steps needed to achieve the outcome. Many advocate taking the time to physically illustrate the final result using radiographs, tracing paper, and implant templates. However, with the advance of digital technology, there are now many computerized templating programs, which surgeons utilize to perform this task. Illustrations allow the surgeon in identifying the best methods to solve the problem at hand. The process allows details to be worked out and intricacies identified on paper rather than in the operating room. This technique helps to develop a three-dimensional understanding of the pathology, soft tissue implications of the procedure, and ultimate strategy to arrive at the solution.

1.2 Surgical Tactic

The surgical tactic is the step-by-step rehearsal of arriving at the desired result. When drafting a surgical tactic, one must remember to record the key steps in the procedure, without cluttering the plan with trivial details. As proposed by AO, ¹ we recommend classifying the surgical tactic as follows:

• 
  

  The patient

  
  
  
  
  • 
    

    Type of anesthesia (general, regional, and local)

    
    
  • 
    

    Need for a tourniquet

    
    
  • 
    

    Patient positioning (supine, prone, and lateral)

    
    
  • 
    

    Operating table (fracture table, flat Jackson, Jackson spine table, and radiolucent table)

    
    
  • 
    

    Room setup

  
  
• 
  

  The procedure

  
  
  
  
  • 
    

    Draping

    
    
  • 
    

    Approach

    
    
  • 
    

    Operative technique

    
    
  • 
    

    Instrumentation and implants

    
    
  • 
    

    Special equipment (cell saver, electrocautery/aquamantys, etc.)

    
    
  • 
    

    Closure materials

    
    
  • 
    

    Alternative techniques

  
  
• 
  

  Supportive services

  
  
  
  
  • 
    

    X-ray

    
    
  • 
    

    Product representatives

  
  
• 
  

  Postoperative care

  
  
  
  
  • 
    

    Immobilization (splint, cast, and brace)

    
    
  • 
    

    Weight-bearing status

    
    
  • 
    

    DVT prophylaxis/antibiotics

Although this is far from an exhaustive list, it is a foundation for a detailed surgical tactic. Rehearsing the steps of the procedure mentally while classifying the steps by the patient, procedure, supportive services, and postoperative care helps to create a comprehensive plan with thorough communication.

1.3 Case Coordination

The last core element of the preoperative planning is coordination of the case to all necessary parties. The logistical details are largely covered in the surgical tactic, but thorough communication of these points to the operating room staff is critical to ensure team understanding and that necessary equipment is ready and available. The type of anesthesia, patient positioning, operating table, need for X-ray, and necessary equipment may be the most important aspects of the surgical tactic to discuss with the staff. ² Needless delays often result from poor communication of these five critical factors. Depending on the surgeon and specialty, an equipment preference list may be kept on file with the operating room, which can be referenced. However, every case is different and a preference list often falls short, illustrating the importance of the preoperative plan for each case.