Prioritisation 5

Scenario

You are the night ST3 at a Major Trauma centre. Please take the handover and arrange the trauma list for tomorrow morning. You have an SHO overnight with you.

Patient list

  1. 50YO swollen knee, septic
  2. 65YO open tib fib
  3. 90YO NOF intracapsular
  4. 85YO periprosthetic hip fracture
  5. 54YO tibial plateau, Shatzker 6
  6. 4YO both bone forearm fracture

Are there any questions you would like to ask regarding the cases?

  • Location – MTC
  • II – ½ day list and II present for whole list
  • Theatres – no other theatres available during the day
  • Consultant – General trauma, not happy to do tibial plateau or periprosthetic hip fractures. Happy to do THRs/Hemis
  • Consented, marked and COVID/MRSA – All complete
  • Kit – available
  • Allergies – nil allergies

50 YO Swollen knee

Native Knee

Aspiration taken – gram stain positive

Patient septic (spiking temperatures, Tachycardic, hypotensive)

Septic 6 started

NBM

 

65YO Open tib fib

Isolated injury – ATLS performed

No gross contamination (no aquatic, sewage or agricultural)

BOAST guideline management until now, ABX, Tetanus, photographs, saline soaked gauze and plastics involvement

In Backslab acceptable position

5cm wound

No signs of compartment syndrome

High mechanism of injury

Time of injury (just come in) – should be within 12 hours, definitive soft tissue coverage within 72 hours.
NVI

 

90YO NOF intracapsular

Isolated injury – ATLS performed

Not on anticoagulation

CXR, ECG and NOF proforma followed

Time of injury – today at 10am (BPT within 36 hours’ time to surgery)

Seen by Orthogeriatrics

AMTS 9/10

Walks with ZF

NICE guidelines state as mobilises with ZF patient should be for Hemiarthroplasty.

NVI

 

85YO periprosthetic hip fracture

CT not done

Consultant not happy to perform

D/W lower limb surgeons

Closed, isolated injury

Medically stable

No significant co-morbidities

Orthogeries review

NVI

 

54YO tibial plateau, Schatzker 6

Closed, isolated injury

No compartment syndrome

CT not performed yet – scheduled for this evening

NVI

In above knee backslab, comfortable

 

4YO both bone forearm fracture

Closed, isolated injury

No NAI concerns

No compartment syndrome

NVI

Angulation (manipulation has been performed in A+E latest angulation and rotation <5 degrees, no shortening).

 

Emergency case for overnight

  • Swollen knee

Theatre list the next day

  • Open tib fib
  • NOF

Delayed until specialist consultant

  • Schatzker 6 – CT for planning
  • Periprosthetic consultant not happy to do procedure – CT for planning

No operation required

  • 4 year old both bone forearm fracture – discuss in MDT but rotation acceptable