Week 8 (parts 1 and 2)

Question 1

part 1

Answer 1

orthopaedic patient management

Question 2

what do these refer to

Answer 2

Garden classification - neck of femur fractures
Schatzker classification - Tibial plateau fractures
Salter-Harris classification - Fractures involving the physis, or growth plate
Weber classification - Ankle fractures
Compartment Syndrome - Complication
Osteomyelitis - bone infection
Lauge-Hansen classification - ankle fractures
DVT - blood clot in the calf
PE - blood clot in the lung affecting respiration

Question 3

what should you do on the ward before seeing the patient

Answer 3

Check patient notes
Reason for admission (HPC), PMH, SH (Stairs? Support? Occupation? Previous mobility?)
Operation notes – WB status, post op instructions / restrictions, peri-operative complications – difficult surgery, blood loss, anaesthetic problems, recovery ward information.
Can we mobilise today? (bloods, BP, awaiting scan, awaiting something else that would affect therapy)
Is it safe to proceed?
Check obs (NEWS chart)
Bloods (Hb)
X-ray
Drug chart for pain relief – routine Vs on request, time of last round, medication given?

Speak to MDT about how they have been: Nurses, HCA, TA, Dr, OT, relatives, physios….
Any concerns?
Have they been up and about already with other staff?
Have they had pain relief? What and when?
Are they medically well?

Question 4

what should you do when with the patient

Answer 4

General observation of how they look – any concerns?
Environment – left over medications, meals, PCA in situ, drips and drains?
Are they confused? Ask them a bit about their SH and you should be able to tell. Is this their baseline?
Post op checks
NV status
Wound
ROM
Strength
How do they feel?

Question 5

what should you do after seeing your patient

Answer 5

Clinical reasoning:
Are they at their baseline?
If not, then why not? (Pain, fragility, anxiety, confusion)
What do we need to do to get them back to this?
Do we think they will be able to return home, or do we need to think about other options? (not always obvious D1 post op as Ortho pt’s can progress quickly once pain is controlled)

Question 6

what else can we do to help patients progress

Answer 6

What else can we do to help them progress?
Exercises – bed exercises, standing exercises, independently or with family support?
Nursing staff to get them out of bed/mobilise them more often
OT assessment for washing / dressing.
If unable to mobilise due to low Hb, low BP etc. Can we do something else with them in the bed?
Exercises
Sit on the edge of bed (if appropriate)
If LL is the issue, could we do UL exercises?

Question 7

part 2

Answer 7

Orthopedics In-patients

Question 8

what is orthopedic in patients

Answer 8

Covers a multitude of injuries admitted to hospital
Trauma vs Elective
Referral Routes
Prehab
Start of Physio input can vary
Assessment starts as soon as they enter the door
MDT collaboration for information sharing
Common mistake is missing non-obvious injury e.g., tibial shaft fracture could miss posterior cruciate ligament fracture
Thorough Subjective + Objective Ax is crucial!

Question 9

what are some common orthopedic conditions

Answer 9

Fractures
Ligament / tendon repairs
Joint arthroplasty (replacements) – THR, TKR, unicompartmental, TSR
Arthrodesis (fusion)
Decompression – e.g. spinal discectomy, laminectomy
Polytrauma – peripheral and spinal injuries, other organ injuries, amputation