Nota Perubatan

Category: Orthopaedics

  • 10 Orthopaedic Emergencies

    1. Open fractures
    2. Pelvic fracture
    3. Fractures over long bones // Fat embolism syndrome
    4. Acute compartment syndrome
    5. Cauda equina syndrome
    6. Septic arthritis
    7. Osteomyelitis
    8. Hip dislocation
    9. Hand abscess
    10. Necrotising fasciitis

    (‘Emergency’ means you CANNOT delay the review & management when you receive referral from your colleagues from ED / other departments; If you delay, you may cause HARM to the patients)

  • Hand Abscess

    Treatment

    • Antibiotics of choice given pre & post-op: Cloxacillin
      • Adjust antibiotics accordingly once C&S result available
    • Definitive treatment: I&D

  • Sutures

    Classification of Suture Materials

    • Absorbable VS Non-absorbable
    • Synthetic VS Natural
    • Monofilament VS Multifilament (i.e. braided)
      • Monofilament: lower risk of infection, but poor knot security
      • Braided: good knot security but higher risk of infection

    Suture Size

    A larger size suture has smaller diameter. Hence a 3/0 suture is smaller than a 2/0 suture.

    Surgical Needle

    • Swaged end
      • Connects the needle to the suture
    • Needle body
      • Round body: for friable tissues e.g. liver, kidney, cervical tear repair
      • Cutting (i.e. triangular shaped, with 3 cutting edges to penetrate tough tissue; cutting surface on the concave edge): For tough tissues e.g. skin
      • Reverse cutting (cutting surface on the convex edge): For tendon / subcuticular sutures
    • Needle point

    Examples

    Composition Example / Brand Natural / Synthetic Absorbable / Non-absorbable Monofilament / Braided
    Silk Silk, VESTISilk Natural Non-absorbable Braided
    Polypropylene Ecolene, VESTilene, PROLENE Synthetic Non-absorbable Monofilament
    Nylon (a type of polyamide) Tylon Synthetic Non-absorbable Braided
    Nylon (a type of polyamide) Dafilon, ETHILON Synthetic Non-absorbable Monofilament
    Polyglactin Vicryl, Vestiryl, Polysorb Synthetic Absorbable Braided
    Poly (Glycolide-co-Lactide) ECOSORB Synthetic Absorbable Braided
    Polyglyconate copolymer of glycolic acid and trimethylene carbonate Monosyn, Maxon Synthetic Absorbable Monofilament
    Collagen Catgut Natural Absorbable Braided
    Glycolide and epsilon-caprolactone Monocryl Synthetic Absorbable Monofilament
    No matches found.

  • Pain as the 5th Vital Sign & Acute Pain Management

    Scales for Pain

    Visual analogue scale (VAS):

    Documentation e.g. VAS 3, VAS – 7

    Modified WHO Analgesic ladder for acute pain management

    Further reading: CPG Pain as the 5th vital sign (3rd edition)

  • R.I.C.E

    RICE treatment for acute musculoskeletal injury aims to relieve pain and swelling and promote healing and flexibility

    • Rest the injured area for 48 hours
    • Ice for 20 minutes at a time; 4 – 8 times a day
    • Compress to help reduce swelling
    • Elevate the injured limb 15 – 25 cm above heart

  • Trigger Finger

    Green Classification of Trigger Finger

    • Grade I: Palm pain and tenderness at A-1 pulley
    • Grade II: Catching of digit
    • Grade III: Locking of digit, passively correctable
    • Grade IV: Fixed, locked digit

    Hence, diagnosis is not simply written as ‘Trigger finger’, but can be written better, e.g. Trigger finger of left ring finger, grade II – grade III

    Treatment (Non-operative)

    • Refer physiotherapy for tendon gliding exercise

  • Femoral Shaft Fracture

    Complications

    📒 Fat embolism syndrome
    📒 Hypovolaemic shock
    📒 Femoral nerve injury / pudendal nerve injury
    📒 Femoral artery injury
    📒 Delayed union / non-union

  • Wound

    Types of wound debridement

    • surgical
    • mechanical
    • enzymatic
    • autolytic
    • biological
    • Hydrosurgery debridement

  • Ortho Miscellaneous Notes

    Common injuries and associated nerve injuries

    1. Shoulder dislocation: axillary nerve
    2. Midshaft humerus: radial nerve
    3. Post K-wire supracondylar humerus: ulnar nerve
    4. Fracture of radial neck: posterior interosseous nerve, PIN
    5. Hip dislocation: Sciatic nerve
    6. Fibular neck fracture: common peroneal nerve

  • Tscherne Classification on Soft Tissue Injury for Closed Fracture

    Grade 0
    Minimal soft tissue damage, indirect violence, mild to moderate fracture

    Grade 1
    Superficial abrasion of contusion caused by pressure from within, mild to moderate fracture

    Grade 2
    Deep contamination abrasions associated with localised skin or muscle contusion, impending compartment syndrome, severe fracture

    Grade 3
    Extensive skin contusion or crushed, underlying severe muscle, decompensated compartment syndrome associated with major vascular injury, severe fracture

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