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
After, and when it goes wrong
Post-op & Emergencies
The expected course, the ward reads, and the calls that cannot wait.
The expected course and the ward reads, then the complications and the calls that cannot wait.
On the ward
Three boards, three reads
POD 1 · hip fracture fixation
Fluctuating attention, worse tonight
Pulling at lines
Sats 93%
Not yet mobilised
Analgesia: PRN only, little given
What is the diagnosis, and what is the prescription?
The read
Delirium, and the prescription is mostly not a drug: treat the causes (pain given regularly rather than on request, hypoxia, retention, constipation, infection), restore glasses, hearing aids, daylight and family, and mobilise today. Sedation is a last resort that worsens the fall risk it responds to. The orthogeriatric review is the most important consult on this chart.
POD 2 · tibial nail
Pain 9/10 despite escalating opioids
Calf tense
Toes moving but stretch hurts
Pulses present
More analgesia?
The read
No: analgesia-resistant pain in a tense compartment after a tibial fracture is compartment syndrome speaking, and the present pulses are a false comfort, since compartments strangle capillaries long before arteries. Dressings split to skin, limb level with the heart, senior review now, and fasciotomy on clinical grounds: the muscle's deadline does not extend for a pain-team referral.
Clinic · painful hip replacement, year 2
Groin pain on standing
CRP 45, ESR 60
X-ray: lucency around the stem
No fevers
What must happen before anyone mentions antibiotics?
The read
Aspiration: this picture (pain, raised markers, early lucency) is prosthetic joint infection until proven otherwise, and the aspirate's culture is the pivot for every later decision. A well-meant course of oral antibiotics now would blunt the cultures, delay the diagnosis, and close no options except the good ones. Sampling first is the whole discipline.
Emergencies
The calls that cannot wait
Compartment syndrome
Recognise: Pain out of proportion and pain on passive stretch in a tense compartment, classically the tibia after fracture or fixation: pulses persist until far too late.
First move: Split every dressing to skin, level the limb, reassess in minutes not hours, and escalate for fasciotomy on clinical grounds: pressure monitors advise, the clinical picture convicts.
The septic native joint
Recognise: A hot, immobile, exquisitely painful joint with fever: cartilage is being digested while the differential is being admired.
First move: Aspirate before antibiotics in the stable patient, then washout and targeted therapy: the joint's surface pays for every hour of delay.
The pulseless supracondylar fracture
Recognise: A child's displaced elbow fracture with a pale, cool, pulseless hand: the brachial artery is kinked, trapped or torn at the fracture.
First move: Urgent reduction is the first vascular treatment; a hand that stays white afterwards goes to theatre for exploration, with the vascular team called rather than awaited.
The open fracture
Recognise: Bone through skin, or a wound over a fracture: graded later, treated now.
First move: Antibiotics within the hour, alignment, splint, photograph, sealed dressing, and the orthoplastic referral started tonight: the first dose of antibiotics is the most important operation of day one.
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.