Orthopedic Surgery

Bone biology, stability, and the emergencies where limbs and joints are kept or lost.

• Orthopaedic surgery treats the skeleton and its soft-tissue machinery: fractures fixed on mechanical principles, worn joints replaced, and the emergencies, open fractures, compartment syndrome, septic joints, where hours decide function.
• Its core science is bone healing: bone is one of the few tissues that heals with itself rather than scar, and every fixation choice is a bet about which healing pathway to invite.
• The hip fracture is the specialty's public-health centrepiece: an operation within a day or two, done once and done well, in a patient whose frailty is the real disease.
• The specialty thinks in stability: is the fracture stable, is the fixation stable, is the joint stable, and the answer decides everything from weight-bearing orders to reoperation.

X-ray

What should I notice?

• The fall that ends in the resus bay

  “An 84-year-old found on the floor: a shortened, externally rotated left leg, and a life's worth of comorbidity on the drug chart.”

  • The leg's attitude names the injury: shortened and externally rotated is a hip fracture until the X-ray says otherwise.
  • The fracture line decides the operation: intracapsular fractures threaten the femoral head's blood supply and often need arthroplasty; extracapsular ones keep their blood and get fixed.
  • Why did they fall is a parallel workup: syncope, infection, medication and the home environment, because fixing the femur without fixing the falling means a second fracture.

  Live it as a case Hip fracture fixation (dynamic hip screw)

• The hot swollen knee

  “A 55-year-old diabetic with two days of an exquisitely painful, swollen knee, held still, with a fever: no injury remembered.”

  • A hot, immobile joint with fever is septic arthritis until proven otherwise, and the proof is the needle: aspirate before antibiotics whenever the patient's stability allows.
  • The differential is gout's mimicry: crystals and infection can coexist, so the aspirate goes for Gram stain, culture, crystals and cell count all together.
  • Pus digests cartilage in days: the treatment is washout of the joint plus antibiotics, not antibiotics alone.

  Live it as a case Arthroscopic washout of septic arthritis

• The open fracture

  “A motorcyclist with a deformed lower leg and bone visible through a wound: contamination, energy and a soft-tissue envelope in trouble.”

  • An open fracture is a soft-tissue injury with a broken bone inside it: the envelope's damage, graded after debridement, predicts the outcome better than the fracture pattern.
  • The first hours' jobs are fixed: antibiotics fast, gross contamination lifted, the limb aligned and splinted, photographs, and a saline-soaked dressing that then stays undisturbed.
  • Definitive care is a joint venture: debridement and skeletal stabilisation with plastic surgery planning the cover, ideally at a centre where both operate together.

  Live it as a case Debridement and fixation of an open tibial fracture

• The painful joint replacement

  “Eighteen months after a hip replacement: two weeks of increasing groin pain, a CRP of 80, and a patient who was previously delighted.”

  • A previously silent arthroplasty that starts hurting has a short list: infection, loosening, instability, and fracture, and infection heads it whenever inflammation rises.
  • Prosthetic joint infection is biofilm disease: organisms glued to metal are beyond antibiotics' reach, which is why treatment is surgical and antibiotic together.
  • The workup is disciplined: inflammatory markers, aspiration of the joint before any antibiotics, and imaging, because an undiagnosed start ruins every later option.

  Live it as a case Total hip arthroplasty

• The child's elbow

  “A seven-year-old off the monkey bars: a swollen elbow held in extension, and a hand that is pale and cool.”

  • The supracondylar fracture is childhood's dangerous elbow: the brachial artery and median nerve run across the fracture's path, and displacement threatens both.
  • The perfusion examination is the emergency triage: a pink, warm hand can wait for the trauma list; a pale, pulseless one is a now problem, reduced urgently and explored if perfusion does not return.
  • Document the nerves before any manipulation: anterior interosseous ('OK' sign), median, radial and ulnar each get ten seconds and a written record.

  Live it as a case