The typical operating room set-up for wrist arthroscopy is for the surgeon to be sitting
next to the patient’s head and the assistant next to the surgeon. The scrub nurse
stands next to the assistant but away from the hand table, as the assistant should be
able to switch places with the surgeon if she/he needs to operate the camera during
certain steps of the procedure. On the opposite side of the patient the shoulder crane
(if one is used for traction) is adjusted to the operating table at the level of the waist
of the patient. Finally, the arthroscopy tower (monitor, pumps etc) seats on the
opposite side next to the patient’s legs facing the surgeon #f.

There are several instances when, in conjunction with arthroscopy one needs
fluoroscopy. There are two ways to set this up. If one needs to have simultaneous
arthroscopic and fluoroscopic views, a mini C-arm can be fully draped and inserted
with the drum of the C-arm between the surgeon and the operated hand. This
however can be quite bothersome and in most instances the arthroscopic and
fluoroscopic assisted parts of surgery can be performed in stages so that a classic
C-arm setup can be used. For example, if one needs to pin the carpal bones for an
intercarpal ligament injury, after the arthroscopic part is completed, the arm is taken
out of traction and pinning is performed with the arm resting on the hand table.

In arthroscopic assistance for distal radius fractures, in which a palmar plate is
planned to be used, the setup of the patient is the same as for arthroscopy but the
patient’s arm is not put in traction from the beginning. The open volar approach is
performed with the patient’s hand resting on the hand table and provisional screws
are inserted under C-arm control. Next the finger traps are attached to the traction
device and wrist arthroscopy is performed making appropriate screw adjustments or
ligament debridement repair while in traction. Finally, in arthroscopic assisted distal
radius fracture fixation, where only pins are planned to be used, the patient’s arm is
adjusted to the traction tower and the mini C-arm is brought in for simultaneous
arthroscopic and fluoroscopic control.