SurgSpace / Specialties / Orthopedic Surgery
Orthopedic Surgery
Bones, joints and the injured limb: fracture fixation from plates to nails, the hip fracture pathway that defines care of the older patient, arthroplasty that trades a worn joint for a working one, and the emergencies, open fractures, compartments, septic joints, where limbs are saved or lost.
Backdrop: Anteroposterior X-ray of a total hip arthroplasty · Mikael Häggström, M.D · CC0
Apply it
Cases & Practice
Patients to decide on, images to interpret, and the first day on the rotation.
Patients to decide on, images to interpret, and the briefing for the first day on the rotation.
Decisions, one patient at a time
Cases
Imaging practice
Read the image, then decide
Surgical decision-making
Does this patient need surgery?
A displaced intracapsular hip fracture in a cognitively intact 74-year-old who walks to the shops daily. Fix, hemiarthroplasty, or total hip replacement?
Fixation
Preserves the native head, mainly for the young and for undisplaced fractures: in displaced older fractures it gambles on a blood supply that often has already lost.
Hemiarthroplasty
Replaces the head only: robust, quick, and the default for frailer, less active patients.
Total hip arthroplasty
Both sides of the joint: better function and less long-term pain for the active, cognitively intact patient who will use the bearing.
The fracture line plus the patient decides: displacement threatens the head's blood supply (favouring replacement), while activity and cognition decide how much joint to rebuild. This is the specialty's everyday example of an operation chosen by the person, not just the picture.
A hot swollen knee and a febrile patient at 23:00; the admitting doctor wants to 'get antibiotics in early'. Aspirate first?
Aspirate, then antibiotics
Minutes of delay for the diagnosis's sake: the aspirate's Gram stain, culture and crystals decide weeks of treatment.
Antibiotics immediately
Right only in sepsis with physiologic compromise, where the septic screen's timing yields to resuscitation: document why, and still aspirate as soon as possible.
In the stable patient the needle comes first: an aspirate taken after antibiotics may never grow the organism, converting a targeted six-week plan into an empirical guess. The exception is genuine septic shock, and the rule survives the exception.
A hip arthroplasty infected three weeks after implantation: acute symptoms, well-fixed implant, known organism. Keep the implant or exchange it?
DAIR
Debridement, antibiotics, implant retention with liner exchange: a real option only in early infection with a well-fixed implant and a treatable organism.
Staged revision
Remove everything, treat with a spacer and antibiotics, reimplant later: the established biofilm's answer, at the cost of two operations and months.
The clock decides: biofilm matures over weeks, and DAIR's window closes as it does. Late 'washouts' of chronically infected implants fail predictably, which is why chronicity assessment, not optimism, chooses the strategy.
The rotation
Your first day here
- Present fractures in one breath: which bone, where, what pattern, displaced how, open or closed, neurovascular status. The formula works for every film you will ever show.
- Document the neurovascular examination before and after every reduction, splint and operation: it is both the patient's safety and yours.
- Pain out of proportion is a diagnosis, not a nuisance: in any tight compartment it means pressure until proven otherwise.
- The hot swollen joint's rule is needle before antibiotics: know it before your first take shift.
- On the hip fracture ward, the orthogeriatricians are half the operation: follow one of their rounds early in the week.
- Learn the theatre choreography of image intensifier cases: standing in the wrong place teaches you nothing and irradiates you slightly.
Hub shaped by the Surgical Specialties Lead with the Orthopaedic surgery reviewer (open seat). Images and videos carry their source; educational use for supervised learning, not clinical guidance.