Orthopaedics

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Orthopaedics

• Trauma and Elective Very Different!

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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

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Elective

• Patient Group
• Usually older 60
• Healthy
• Generally alert and orientated

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Elective

• All Planned admissions
• Patients are well dont get surgery if they are
  ill
• Patients know what to expect it is all
  explained before
• Wound only other injury

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Physiotherapists Role

• Mobilising
• Gait Re-education
• Walking aids
• Improving ROM
• Monitoring swelling
• Improving muscle power
• Arranging OP physio

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MDT

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

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Assessment

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

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Complications

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

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Transferable Knowledge

• Assessment
• Gait Re-education
• Use of walking aids

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ELECTIVE ORTHO

• Pre assessment clinic or in ward
• Subjective
• Objective hip or knee
• Pre op talk

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Pre op talk

• Post op regime
• Circulation exs
• Chest care and o2 therapy
• Catheter and drains, IV fluids, PCA
• Splints
• Bed mobility, bridging
• Measure for ZWA

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Post op regime THR

• POD 1 chest care, TAQs and gluts, bed exs,
  measure ROM
• POD 2 check x-ray, T/Fs, leg elevated
• POD 3-7 progress to E/Cs, gradual ? exs and
  tolerance, stair practice

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Post-op regime TKR

• POD 1 chest care, TAQ-s and gluts, AROM and
  PROM
• POD 2 check x-ray, mobilise, T/Fs, ? AROM and
  PROM, ? quads
• POD 3-7 - ? mobility, cryocuff after dressings
  reduced drains removed, progress to sticks and
  stair practice

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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

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• 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

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Other conditions

• Pathological
• Infection
• Removal of metal work
• Cellulitis
• Spinal, clavicle, pelvic
• Compartment syndrome
• Drug related problems

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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

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Lower Limb

• NOF
• Typical pts elderly falls, osteoporosis,patholog
  ical
• Types
• Intracapsular subcapital or transcervical
• (avascular necrosis)
• Extracapsular intertrochanteric or
  transtrochanteric

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• 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

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TYPES OF FIXATION
CANNULATED SCREWS
BI-POLAR
DYNAMIC HIP SCREW
MOORES
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• Knee
• Typical pts 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 PS, dynamic
  compression screw
• Tension Band Wiring some Patella s
• External Fixation severely comminuted plateau

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PATELLA AND FIXATION
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• Tibia / Fibula s
• Typical pts RTA, sporting injuries, twisting
  injuries
• Types
• Transverse
• Oblique/spiral
• Comminuted
• Fixation
• Stable cast immobilisation, Steinmann pins (NWB)
• Unstable/displaced ORIF, PS, compression
  plates, IM nail
• Contaminated unstable External Fixation
• NB Compartment Syndrome big risk ? Fasciotomy

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• Ankle/Foot
• Typical pts 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

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ANKLE FRACTURES