ORT601 — Principles of Orthopaedic Surgery: Lecture Note

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la-NET | ONLINE LEARNING VIDEO PLATFORM FOR POST-SECONDARY & HIGHER INSTITUTION STUDENTS

la-NET | ONLINE LEARNING VIDEO PLATFORM FOR POST-SECONDARY & HIGHER INSTITUTION STUDENTS Course code: ORT 601 Course title: Principles of Orthopaedic Surgery Course credit load: 4 Units Series 1: Clinical Approach and Management of the Injured Patient • Part 1.1: Clerking and Examination in Orthopaedics o Sub Part 1.1.1: Orthopaedic history taking o Sub Part 1.1.2: Apley's principles: look o Sub Part 1.1.3: Apley's principles: feel and move • Part 1.2: General Approach to the Injured Patient o Sub Part 1.2.1: Initial assessment principles o Sub Part 1.2.2: Field management of the injured patient o Sub Part 1.2.3: Hospital management on arrival • Part 1.3: ATLS Primary Survey o Sub Part 1.3.1: Airway and breathing assessment o Sub Part 1.3.2: Circulation and disability assessment o Sub Part 1.3.3: Exposure and environmental control • Part 1.4: ATLS Resuscitation Principles o Sub Part 1.4.1: Principles of resuscitation in the multiply injured patient o Sub Part 1.4.2: Fluid resuscitation and haemorrhage control o Sub Part 1.4.3: Reassessment during resuscitation • Part 1.5: Secondary Survey o Sub Part 1.5.1: Principles and timing of the secondary survey o Sub Part 1.5.2: Head-to-toe examination in the secondary survey o Sub Part 1.5.3: Outlining injuries to plan definitive management • Part 1.6: Multidisciplinary Management of the Multiply Injured Patient o Sub Part 1.6.1: The multidisciplinary team in trauma care o Sub Part 1.6.2: Planning definitive management o Sub Part 1.6.3: Communication and handover in multidisciplinary trauma care

la-NET | ONLINE LEARNING VIDEO PLATFORM FOR POST-SECONDARY & HIGHER INSTITUTION STUDENTS Introduction Welcome to ORT 601: Principles of Orthopaedic Surgery. Confident orthopaedic and trauma practice begins with disciplined clinical clerking and examination, and, for the injured patient, a systematic, protocol-driven approach spanning field management through ATLS resuscitation, secondary survey, and coordinated multidisciplinary definitive care. This opening Series establishes both of these essential foundations, forming the basis for every subsequent orthopaedic topic examined throughout this course. The aim of this Series is to equip you with a thorough understanding of orthopaedic clerking and examination, the general approach to the injured patient, ATLS primary survey and resuscitation principles, the secondary survey, and the multidisciplinary management of the multiply injured patient. This Series begins with clerking and examination in orthopaedics, before turning to the general approach to the injured patient. We then examine the ATLS primary survey, followed by ATLS resuscitation principles, then the secondary survey, concluding with the multidisciplinary management of the multiply injured patient. Series Learning Outcomes At the end of this Series, you should be able to: • SLO 1.1: take a systematic orthopaedic history • SLO 1.2: apply Apley's principles of look, feel, and move in orthopaedic examination • SLO 1.3: enumerate the general approach to an injured patient • SLO 1.4: describe field and hospital management of the injured patient • SLO 1.5: perform the ATLS primary survey, assessing airway, breathing, circulation, disability, and exposure • SLO 1.6: describe the sequence and rationale of the ATLS primary survey • SLO 1.7: describe the principles of resuscitation in the multiply injured patient, including fluid resuscitation and haemorrhage control • SLO 1.8: describe the importance of continuous reassessment during resuscitation • SLO 1.9: describe the principles, timing, and conduct of the secondary survey • SLO 1.10: outline injuries identified on secondary survey to plan definitive management

la-NET | ONLINE LEARNING VIDEO PLATFORM FOR POST-SECONDARY & HIGHER INSTITUTION STUDENTS • SLO 1.11: describe the role of the multidisciplinary team in trauma care, and • SLO 1.12: describe the planning of definitive management and effective communication and handover in multidisciplinary trauma care. 1.1 Clerking and Examination in Orthopaedics 1.1.1 orthopaedic history taking Establishing the presenting complaint and its functional impact Orthopaedic clerking should establish the specific nature, onset, and progression of the presenting complaint, generally pain, deformity, swelling, or loss of function, together with relevant mechanism of injury where trauma is involved, discussed further later in this Series. Further essential history includes the functional impact of the presenting problem on the patient's daily activities and occupation, relevant past medical and surgical history, particularly prior orthopaedic intervention, and social history relevant to rehabilitation planning and eventual return to normal function. Fill in the blank: Orthopaedic clerking should establish the specific nature, onset, and progression of the presenting complaint, together with relevant mechanism of ________ where trauma is involved. 1.1.2 apley's principles: look Apley's principles of orthopaedic examination begin with look, systematic visual inspection of the affected region, assessing skin colour and integrity, swelling, deformity, muscle wasting, and scars from previous surgery, generally performed with the patient adequately exposed and compared directly against the contralateral, unaffected side. Inspection additionally includes assessment of the patient's overall posture and gait where relevant, discussed further in relation to specific conditions throughout this course, since these broader observations frequently provide valuable diagnostic clues before any direct palpation or movement assessment has even begun. Fill in the blank: Apley's principles of orthopaedic examination begin with look, generally performed with the patient adequately exposed and compared directly against the contralateral, unaffected ________.

la-NET | ONLINE LEARNING VIDEO PLATFORM FOR POST-SECONDARY & HIGHER INSTITUTION STUDENTS 1.1.3 apley's principles: feel and move Feel, the second component of Apley's principles, involves systematic palpation to assess temperature, tenderness, swelling character, and specific anatomical landmarks, generally performed gently and progressively, moving from areas away from the presenting complaint toward the specific area of maximal concern. Move, the final component, assesses both active movement, performed independently by the patient, and passive movement, performed by the examiner, comparing range of motion against the contralateral side, discussed earlier in this Part, and noting any pain, crepitus, or restriction encountered during assessment. Fill in the blank: Apley's principles conclude with move, assessing both active movement, performed independently by the patient, and passive movement, performed by the ________. Figure 1.1: Diagram illustrating Apley's three-stage orthopaedic examination sequence of look, feel, and move. Pilot questions 1.1

la-NET | ONLINE LEARNING VIDEO PLATFORM FOR POST-SECONDARY & HIGHER INSTITUTION STUDENTS 1. List the essential components of a systematic orthopaedic history. (Linked to SLO 1.1) 2. State Apley's three principles of orthopaedic examination. (Linked to SLO 1.2) 3. Describe what is assessed during the look component of orthopaedic examination. (Linked to SLO 1.2) 4. Describe what is assessed during the feel component of orthopaedic examination. (Linked to SLO 1.2) 5. Distinguish active from passive movement assessment. (Linked to SLO 1.2) 1.2 General Approach to the Injured Patient 1.2.1 initial assessment principles A structured, protocol-driven approach to the injured patient The general approach to an injured patient follows a structured, sequential process, generally beginning with rapid assessment of immediately life-threatening problems, discussed further in relation to the primary survey later in this Series, before proceeding to more detailed assessment of the specific injuries sustained. This structured approach reflects the principle of addressing the greatest immediate threat to life first, rather than the most visually striking or painful injury, meaning disciplined adherence to a consistent, protocol-driven sequence, discussed throughout this Series, represents an essential safeguard against missed, potentially fatal injuries. Fill in the blank: The general approach to an injured patient reflects the principle of addressing the greatest immediate threat to life first, rather than the most visually striking or painful ________. 1.2.2 field management of the injured patient Field management of the injured patient generally prioritises basic airway maintenance, control of obvious external haemorrhage, discussed further later in this Series, and appropriate immobilisation of suspected fractures or spinal injury before transport to definitive hospital care. Effective field management additionally requires accurate, concise communication of the mechanism of injury and initial clinical findings to the receiving hospital team, discussed further

la-NET | ONLINE LEARNING VIDEO PLATFORM FOR POST-SECONDARY & HIGHER INSTITUTION STUDENTS later in this Series, supporting appropriate advance preparation and ensuring genuine continuity of care across the entire prehospital to hospital transition. Fill in the blank: Field management generally prioritises basic airway maintenance, control of obvious external haemorrhage, and appropriate immobilisation before ________ to definitive hospital care. 1.2.3 hospital management on arrival On hospital arrival, the injured patient should undergo an immediate, structured handover from prehospital providers, discussed earlier in this Part, before proceeding directly to the primary survey, discussed further in the next Part of this Series, without unnecessary delay for administrative processes that could postpone recognition of immediately life-threatening injury. Hospital management additionally requires immediate availability of appropriate resuscitation equipment and personnel, discussed further later in this Series, together with rapid access to supportive investigations, discussed in relation to imaging in an earlier related course, each essential to the efficient, coordinated trauma response every injured patient deserves. Fill in the blank: On hospital arrival, the injured patient should proceed directly to the primary survey without unnecessary delay for administrative processes that could postpone recognition of immediately life-threatening ________. Table 1.2: Comparing field and hospital management priorities for the injured patient. Setting Immediate priority Key supporting action Field (prehospital) Airway maintenance and haemorrhage control Immobilisation and rapid transport Hospital Primary survey

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