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 1 st day post-op

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

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