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Published byRemington Gelling Modified over 10 years ago
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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 – don’t get surgery if they are ill Patients know what to expect – it is all explained before Wound – only other injury
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Physiotherapist’s 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 – physio’s 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 ex’s 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, 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
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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/F’s, 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 pt’s: elderly falls, osteoporosis,pathological 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 1 st day post-op
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TYPES OF FIXATION DYNAMIC HIP SCREW MOORES BI-POLAR CANNULATED SCREWS
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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
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PATELLA # AND FIXATION
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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
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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
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ANKLE FRACTURES
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