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Orthopaedics

Orthopaedics. Trauma and Elective – Very Different!. Trauma. Patient Group – Anyone! Can have any injury – possibly multiple injuries – including soft tissue Patients can be quite ill All unplanned admissions – following an incident. Elective. Patient Group Usually older – 60+ Healthy

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Orthopaedics

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  1. Orthopaedics Trauma and Elective – Very Different!

  2. Trauma • Patient Group – Anyone! • Can have any injury – possibly multiple injuries – including soft tissue • Patients can be quite ill • All unplanned admissions – following an incident

  3. Elective • Patient Group • Usually older – 60+ • Healthy • Generally alert and orientated

  4. Elective • All Planned admissions • Patients are well – don’t get surgery if they are ill • Patients know what to expect – it is all explained before • Wound – only other injury

  5. Physiotherapist’s Role • Mobilising – • Gait Re-education • Walking aids • Improving ROM • Monitoring swelling • Improving muscle power • Arranging OP physio

  6. MDT • Important to liaise with all members and be aware of others jobs • Crucial to follow consultants instructions • Ensure pain is controlled • Very integrated – physio’s play a major role in patient status e.g. for discharge.

  7. Assessment • Elective – • Pre-op, • Basic subjective and objective, • Predominantly hip and knee • Trauma – • After the incident, • Also soft tissue injuries

  8. Complications • Infection • Blood Loss • DVT • Reactions to Drugs • Compartment Syndrome • Dislocation • Fat Embolism

  9. Transferable Knowledge • Assessment • Gait Re-education • Use of walking aids

  10. ELECTIVE ORTHO • Pre assessment – clinic or in ward • Subjective • Objective – hip or knee • Pre – op talk

  11. Pre – op talk • Post –op regime • Circulation ex’s • Chest care and o2 therapy • Catheter and drains, IV fluids, PCA • Splints • Bed mobility, bridging • Measure for ZWA

  12. Post –op regime THR • POD 1 – chest care, TAQ’s and gluts, bed ex’s, measure ROM • POD 2 – check x-ray, T/F’s, leg elevated • POD 3-7 – progress to E/C’s, gradual  ex’s and tolerance, stair practice

  13. Post-op regime TKR • POD 1 – chest care, TAQ-s and gluts, AROM and PROM • POD 2 – check x-ray, mobilise, T/F’s,  AROM and PROM,  quads • POD 3-7 -  mobility, cryocuff after dressings reduced + drains removed, progress to sticks and stair practice

  14. Trauma to the Upper Limb Humeral # Nerves that may be affected when the associated part of the humerus is fractured: • Surgical neck  axillary nerve • Radial groove  radial nerve • Distal end of humerus  medial nerve • Medial condyle  ulnar nerve

  15. Olecranon # • Pinning often required because of the traction produced by the tonus of the triceps • Supracondylar # • Radius and/or Ulna # • Colles’ # • Usually results from a fall on an outstretched hand • Bony union usually good because of rich blood supply to distal end of radius • Scaphoid # • Most frequently # carpal bone • Possibility of avascular necrosis

  16. Other conditions • Pathological # • Infection • Removal of metal work • Cellulitis • Spinal, clavicle, pelvic # • Compartment syndrome • Drug related problems

  17. Management • Conservative measures • Immobilisation in slings, collar and cuff, tubigrip, splinting materials, plaster of paris (POP), backslabs • Internal Fixation • Screws, plates, intramedullary nailing, wiring • External Fixators

  18. Lower Limb # NOF # Typical pt’s: elderly falls, osteoporosis,pathological Types: • Intracapsular: subcapital or transcervical (*avascular necrosis) • Extracapsular: intertrochanteric or transtrochanteric

  19. Fixation: • Cannulated screws: incomplete, impacted # • Hemiarthroplasty (Moores/Bi-polar) • Dynamic Hip Screw (DHS): intertrochanteric • Plates and Nails: extracapsular # NB: Normally FWB as tolerated 1st day post-op

  20. TYPES OF FIXATION CANNULATED SCREWS BI-POLAR DYNAMICHIP SCREW MOORES

  21. Knee # Typical pt’s: High energy trauma,ie RTA, direct blow/fall Types: • Supracondylar # Femur: intra/extra articular, uni/bicondylar • Patella #: longitudinal, transverse, comminuted • Tibial Plateau: intra-articular • Avulsion #: violent quads contraction Fixation: • Undisplaced: long leg POP cast + NWB • Displaced/comminuted: ORIF P+S, dynamic compression screw • Tension Band Wiring: some Patella #’s • External Fixation: severely comminuted plateau

  22. PATELLA # AND FIXATION

  23. Tibia / Fibula #’s Typical pt’s: RTA, sporting injuries, twisting injuries Types: • Transverse • Oblique/spiral • Comminuted Fixation: • Stable: cast immobilisation, Steinmann pins (NWB) • Unstable/displaced: ORIF, P+S, compression plates, IM nail • Contaminated + unstable: External Fixation NB: Compartment Syndrome big risk  Fasciotomy

  24. Ankle/Foot # Typical pt’s: Abbduction, adduction, ext.rot, vertical compression. Types: • Medial/Lateral malleoli • ‘Posterior malleolus’ • Talus # (*avascular necrosis) • Calcaneum # • Fracture dislocations Fixation: • Conservative: POP,Moonboot, AFO • ORIF: screws, plates, tension band wiring

  25. ANKLE FRACTURES

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