ORT603 — Clinics, Theatre and Bed Side Teaching in Orthopaedics: Lecture Note

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la-NET | ONLINE LEARNING VIDEO PLATFORM FOR POST-SECONDARY & HIGHER INSTITUTION STUDENTS Course code: ORT 603 Course title: Clinics, Theatre and Bed Side Teaching in Orthopaedics Course credit load: 3 Units Series 1: History Taking in Orthopaedic Practice • Part 1.1: Introduction to Orthopaedic Clinical Practice o Sub Part 1.1.1: Definition and scope of orthopaedic practice o Sub Part 1.1.2: Epidemiology of orthopaedic conditions o Sub Part 1.1.3: Aetiology and classification of orthopaedic conditions • Part 1.2: Presenting Complaint and History of Present Illness o Sub Part 1.2.1: Eliciting the presenting complaint o Sub Part 1.2.2: Characterising pain in orthopaedic history taking o Sub Part 1.2.3: History of present illness: onset, progression, and associated symptoms • Part 1.3: Past Medical, Surgical, Drug, and Family History o Sub Part 1.3.1: Past medical and surgical history relevant to orthopaedics o Sub Part 1.3.2: Drug history and allergies o Sub Part 1.3.3: Family history in orthopaedic conditions • Part 1.4: Social and Functional History o Sub Part 1.4.1: Social history relevant to orthopaedic practice o Sub Part 1.4.2: Functional history and activities of daily living o Sub Part 1.4.3: Occupational and recreational history • Part 1.5: Trauma History and Systematic Review of Systems o Sub Part 1.5.1: History taking in the trauma patient o Sub Part 1.5.2: Mechanism of injury and its clinical significance o Sub Part 1.5.3: Systematic review of systems in orthopaedic clerking Introduction

la-NET | ONLINE LEARNING VIDEO PLATFORM FOR POST-SECONDARY & HIGHER INSTITUTION STUDENTS Confident bedside orthopaedic practice begins with detailed, systematic history taking, grounded in an understanding of the definition, epidemiology, aetiology, and classification of the conditions encountered, and extended through careful enquiry into the presenting complaint, relevant background history, and, where trauma is involved, the specific mechanism of injury. This opening Series establishes this essential clinical skill, forming the foundation for every subsequent clinical encounter examined throughout this course. The aim of this Series is to equip you with a thorough, practical understanding of orthopaedic clinical practice, and detailed history taking covering the presenting complaint, past medical, surgical, drug, and family history, social and functional history, and trauma history. This Series begins with an introduction to orthopaedic clinical practice, before examining the presenting complaint and history of present illness. We then turn to past medical, surgical, drug, and family history, followed by social and functional history, concluding with trauma history and systematic review of systems. Series Learning Outcomes At the end of this Series, you should be able to: • SLO 1.1: define the scope of orthopaedic practice and describe the epidemiology of common orthopaedic conditions • SLO 1.2: describe the aetiology and classification of orthopaedic conditions • SLO 1.3: elicit a presenting complaint and characterise pain in orthopaedic history taking • SLO 1.4: take a systematic history of present illness, including onset, progression, and associated symptoms • SLO 1.5: take a relevant past medical and surgical history in orthopaedic practice • SLO 1.6: take a drug history, including allergies, and a relevant family history • SLO 1.7: take a relevant social history in orthopaedic practice • SLO 1.8: take a functional history covering activities of daily living, occupation, and recreation • SLO 1.9: take a systematic history from a trauma patient, including mechanism of injury, and • SLO 1.10: conduct a systematic review of systems in orthopaedic clerking.

la-NET | ONLINE LEARNING VIDEO PLATFORM FOR POST-SECONDARY & HIGHER INSTITUTION STUDENTS 1.1 Introduction to Orthopaedic Clinical Practice 1.1.1 definition and scope of orthopaedic practice A discipline spanning bone, joint, and soft tissue disorders Orthopaedic practice is concerned with the diagnosis, treatment, and prevention of disorders affecting the musculoskeletal system, encompassing bones, joints, muscles, tendons, ligaments, and peripheral nerves, discussed in relation to specific anatomical structures in an earlier related course, spanning both traumatic and non-traumatic conditions. The scope of orthopaedic practice extends across the entire lifespan, from congenital conditions presenting at birth, discussed in an earlier related course, through childhood growth disorders, to degenerative and traumatic conditions affecting adults and the elderly, reflecting the genuinely broad clinical territory this discipline covers. Fill in the blank: Orthopaedic practice is concerned with the diagnosis, treatment, and prevention of disorders affecting the musculoskeletal system, spanning both traumatic and non-traumatic ________. 1.1.2 epidemiology of orthopaedic conditions The epidemiology of orthopaedic conditions varies considerably by patient age, sex, and geographic setting, with traumatic injury representing a particularly substantial contributor to orthopaedic disease burden within many resource-limited settings, reflecting road traffic collisions and occupational injury patterns discussed in relation to trauma later in this Series. Further important epidemiological considerations include the rising burden of degenerative joint disease with an ageing population, and the specific regional prevalence of conditions such as tuberculous arthritis, discussed in an earlier related course, and sickle cell disease-related bone complications, each relevant to understanding the local orthopaedic disease profile. Fill in the blank: The epidemiology of orthopaedic conditions varies considerably by patient age, sex, and geographic setting, with traumatic injury representing a particularly substantial contributor to orthopaedic disease ________. 1.1.3 aetiology and classification of orthopaedic conditions Orthopaedic conditions may be classified according to their underlying aetiology, including traumatic, discussed throughout this course, congenital, discussed in an earlier related course, infective, discussed in an earlier related course, degenerative, neoplastic, discussed in an earlier

la-NET | ONLINE LEARNING VIDEO PLATFORM FOR POST-SECONDARY & HIGHER INSTITUTION STUDENTS related course, and metabolic causes, discussed in relation to bone metabolism in an earlier related course. This aetiological classification directly informs the specific pattern of history and examination findings expected for a given condition, meaning careful attention to the likely underlying aetiology, guided by the patient's age, presentation, and relevant history, discussed further throughout this Series, supports efficient, focused clinical assessment. Fill in the blank: Orthopaedic conditions may be classified according to their underlying aetiology, including traumatic, congenital, infective, degenerative, neoplastic, and ________ causes. Figure 1.1: A simple classification diagram grouping orthopaedic conditions by aetiology: traumatic, congenital, infective, degenerative, neoplastic, and metabolic. Pilot questions 1.1 1. Define the scope of orthopaedic practice. (Linked to SLO 1.1) 2. Explain why traumatic injury represents a substantial contributor to orthopaedic disease burden in many settings. (Linked to SLO 1.1) 3. List six aetiological categories used to classify orthopaedic conditions. (Linked to SLO 1.2)

la-NET | ONLINE LEARNING VIDEO PLATFORM FOR POST-SECONDARY & HIGHER INSTITUTION STUDENTS 4. Explain how aetiological classification supports efficient clinical assessment. (Linked to SLO 1.2) 5. Describe how the epidemiology of orthopaedic conditions varies by patient age. (Linked to SLO 1.1) 1.2 Presenting Complaint and History of Present Illness 1.2.1 eliciting the presenting complaint Beginning with the patient's own words The presenting complaint should be elicited using an open-ended initial question, allowing the patient to describe their concern in their own words, before the interviewer proceeds to more focused, specific enquiry, generally recording the presenting complaint using the patient's own terminology wherever practicable. Common orthopaedic presenting complaints include pain, discussed further in the next sub-Part, deformity, swelling, stiffness, instability, and loss of function, with each specific complaint type directing subsequent, more detailed enquiry appropriate to that particular symptom. Fill in the blank: The presenting complaint should be elicited using an open-ended initial question, generally recorded using the patient's own ________ wherever practicable. 1.2.2 characterising pain in orthopaedic history taking Orthopaedic pain should be systematically characterised according to its precise site and radiation, onset, whether sudden or gradual, character, discussed further in the next sub-Part, severity, and any factors that specifically aggravate or relieve the pain. Further important pain characteristics include timing, whether constant or intermittent, and specifically whether pain occurs at rest, during activity, or, of particular diagnostic significance, at night, since night pain frequently carries specific diagnostic implications relevant to inflammatory or neoplastic causes, discussed in an earlier related course. Fill in the blank: Orthopaedic pain characterisation includes whether pain occurs at rest, during activity, or, of particular diagnostic significance, at ________.

la-NET | ONLINE LEARNING VIDEO PLATFORM FOR POST-SECONDARY & HIGHER INSTITUTION STUDENTS 1.2.3 history of present illness: onset, progression, and associated symptoms The history of present illness should establish a clear timeline, from initial onset through to the current presentation, noting whether the condition has remained static, progressively worsened, or followed a fluctuating, relapsing-remitting course over time. Associated symptoms, including systemic features such as fever or weight loss, discussed in relation to infective and neoplastic aetiology earlier in this Series, and specific neurological symptoms such as numbness or weakness, discussed in relation to nerve injury in an earlier related course, provide further essential diagnostic information. Fill in the blank: The history of present illness should establish a clear timeline, noting whether the condition has remained static, progressively worsened, or followed a fluctuating, relapsing-remitting course over ________. Figure 1.2: A clinician taking a structured pain history from a seated patient, using a body diagram to mark the site of pain. Pilot questions 1.2

la-NET | ONLINE LEARNING VIDEO PLATFORM FOR POST-SECONDARY & HIGHER INSTITUTION STUDENTS 1. Describe how the presenting complaint

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