INTRODUCTION
Be prepared to learn! Trauma and orthopaedics is a huge subject that is only sparsely taught at medical school (Box 1). Time on-call in orthopaedics can be stressful due to a high demand for decisions on the many different referrals to the specialty. We present brief guidance on how to avoid major pitfalls and get the most benefit from your time in this specialty as a GP trainee.
Box 1. Glossary of terms
Orthopaedics, like many medical specialties, suffers from jargon so we present a beginners guide to some of the common terms used:
- NOF
- Neck of femur.
- SUFE
- Slipped upper femoral epiphysis.
- ORIF
- Open reduction and internal fixation. This is an operation to fix a fracture where a cut is made in the skin, the bone ends reduced directly (OR) and then held in place using a device such as a plate and screws (IF).
- K-wire
- Kirschner wire. A pointed wire which can be passed through the skin to hold a fracture in position. In wrist fractures this often prevents the need for ORIF.
- MUA
- Manipulation under anaesthetic. The patient is anaesthetised and then the fracture is reduced usually under X-ray guidance. This may prevent the need for K-wiring or ORIF.
- DHS
- Dynamic hip screw.
- IM nail
- Intra-medullary nail.
- POP
- Plaster of Paris.
- Non-union
- Bones have not healed.
- Mal-union
- Bones have healed in an incorrect position.
1. The most common presentation to the majority of trauma departments is a fractured neck or femur in older people. These patients are potentially the most unwell and frail group in the hospital and you must take care to ensure they are seen early, fully investigated, and have sufficient intravenous fluids and analgesia. Patients who have this injury under the age of 65 years should be urgently referred to a senior as they may require emergency fixation.
2. Remind yourself how to describe fractures before starting, try using the following order:
open/closed fracture (avoid compound);
the location of the fracture in the bone (for example, midshaft/proximal/distal);
which bone and what side;
describe the appearance of the fracture (transverse/oblique/spiral/multifragmentory); and
describe displacement in terms of angulation (the angle the distal fragment makes with the proximal) and translation (the percentage that the bones have slipped off one another, [0-100% and off ended]).
3. Go and see some surgery! Your department will thank you for being able to consent patients for operations that they are likely to receive. To do this you should have a full appreciation of the risks and benefits of common procedures and be able to describe what is going to happen.
4. Ensure that each injury you see …