Orthopaedics
Orthopaedic Procedures and Counselling
Orthopaedic procedures and counselling for MBBS and NEET-PG: casts, traction, external and internal fixation, amputation, informed consent and rehabilitation, mapped to NMC codes OR13 and OR14.
MedNext Academy | 3 min read
Orthopaedic Procedures and Counselling
Orthopaedic procedures and counselling for MBBS and NEET-PG: casts, traction, external and internal fixation, amputation, informed consent and rehabilitation, mapped to NMC codes OR13 and OR14.
This chapter covers the common orthopaedic procedures and the communication skills that surround them. It works through casts and traction, external and internal fixation and amputation, and the counselling a patient needs on the risks of a tight cast, the process of informed consent and the central role of rehabilitation.
High-yield: Orthopaedic Procedures and Counselling
- A plaster cast or slab immobilises a fracture, and the limb must be watched for the signs of a tight cast: increasing pain, swelling and altered sensation.
- A cast that is too tight can cause compartment syndrome, so a patient must be counselled on the warning signs before discharge.
- Skin traction applies a limited pull through adhesive strapping, while skeletal traction applies a heavier pull directly through a pin in bone.
- External fixation stabilises a fracture with pins connected to an outside frame and is valuable in open and heavily contaminated injuries.
- Pin site care is essential with external fixation and skeletal traction to prevent pin track infection.
- The principles of reduction are to restore length, alignment and rotation, followed by holding the reduction and allowing rehabilitation.
- Open reduction and internal fixation restores the anatomy directly and allows early movement but carries the risks of surgery and infection.
- Amputation may be needed for an unsalvageable limb, and preserving stump length and a good soft tissue envelope improves prosthetic fitting.
- Informed consent requires explaining the diagnosis, the proposed procedure, its benefits, its risks and the alternatives in language the patient understands.
- Counselling a patient before joint replacement should cover realistic expectations, rehabilitation and the risks of infection and loosening.
- A patient in a cast should be advised to elevate the limb and to exercise the free joints to reduce swelling and stiffness.
- Deep vein thrombosis prophylaxis and early mobilisation are important parts of counselling after lower limb surgery and immobilisation.
- Rehabilitation and physiotherapy are integral to recovery after any fracture or orthopaedic operation, not an afterthought.
- Documenting the neurovascular status before and after any reduction or cast application is a basic safeguard.
Immobilisation and fixation
- **Cast or slab:** Non-operative immobilisation. Counsel on tight cast signs: pain, swelling, altered sensation.
- **Traction:** Skin traction for light pull, skeletal traction through a bone pin for heavier pull.
- **External fixation:** Pins to an outside frame, useful in open and contaminated fractures. Needs pin site care.
- **Open fixation:** Direct anatomical restoration and early movement, but carries surgical and infection risk.
NMC competencies in this chapter
- **OR13.1:** Principles of casts, splints and traction in fracture management
- **OR13.2:** Principles of reduction and fixation of fractures
- **OR14.1:** Counselling and informed consent in orthopaedic practice
- **OR14.2:** Counselling on rehabilitation and prevention of complications
- **OR14.3:** Communication and shared decision making with patients and families
- **OR2.15:** Recognition and counselling on complications of immobilisation
Frequently Asked Questions
What warning signs should a patient in a cast be told about?
Increasing pain, swelling, numbness, tingling or colour change in the fingers or toes. These can signal a tight cast or compartment syndrome and mean the patient should return urgently.
What is the difference between skin and skeletal traction?
Skin traction applies a limited pull through adhesive strapping on the skin, while skeletal traction applies a heavier and more sustained pull directly through a pin passed into bone.
What does valid informed consent require?
The patient must understand the diagnosis, the proposed procedure, its likely benefits, its material risks and the reasonable alternatives, and must consent voluntarily and with capacity.
Why is rehabilitation part of orthopaedic management?
Restoring the bone is only half the job. Physiotherapy and graded activity recover movement, strength and function and prevent stiffness and thrombosis, so they are planned from the start.
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