Orthopaedics and Fractures

Hi all, it’s Jarred back again for a blog post. As you guys know, I went on work experience last week at the local hospital, New Cross, where I attended the Fracture and Orthopaedic clinics. Whilst there, I experienced so many different opportunities, and enjoyed all of them immensely. One of the main things I did was observe the plaster technicians as they did their work on patients who had been sent with injuries. I learnt tons of different types of casts/splints, such as a blackslab (which is used as an emergency A&E cast as temporary immobilisation), posterior casts (the general type of casts used to relieve pain and immobilise) and gutter casts (which tend to include two or more fingers). On top of this, they taught me of the different materials that casts can be made from: plaster of paris, Fibreglass and synthetic plaster. All of these have different benefits to being used. Plaster of Paris is cheap, solid and perfect for regular breaks. Fibreglass is extremely hard, so useful to make weight-bearing casts, whilst also perfect for immobilisation. Finally, synthetic soft cast is beneficial as it does not turn solid. This means that it is much lighter, and also better for use with kids, as it can be cut off instead of using a plaster saw to cause less distress.

In addition to observing the plaster technicians, I also sat in on two types of clinics ran by the orthopaedic Doctors, the trauma clinic and the review clinic. In the trauma clinics, the Doctors will see patients who come in with new injuries – often from A&E – which need clinically examining, assessing, a diagnosis made and treatment decided on. During this I saw many different injuries (which I’ll mention later) and started to learn how to interpret X-rays, which personally I found extremely interesting and it piqued my interest. What happens next is a prime example of how a multidisciplinary team works within a hospital. The patient tends to come from the A&E Doctors and will see Doctors who will diagnose them. They are then handed off to a nurse for minor treatments (like splints or wound treatment), the nurse will then pass them on to the plaster technicians for any complex casts etc. Often here, the clinic Doctor will come back in to check on the patient, and they are then sent to another team to get an X-ray. From there, the Doctor will interpret an X-ray and the patient is either let go, or a porter is called to transport them… Now, as you can see, this process involves 5/6 different types of staff (often with multiple of each) so is clearly an example of good teamwork as the patients are treated successfully, and also of excellent communication, as the same patients information goes through many people and everything goes smooth! In the review clinics, patients are seen who have previous injuries that need checking, or have been operated on and the work needs checking. These were very interesting, as I got to witness the after-care of patients by the Doctors, and was able to identify the more relaxed but attentive attitude the Doctors had with the patients.

Now, there are two cases that I saw whilst there that I’d like to mention: a case of Carpal Tunnel (which I researched and was intrigued by) and also a scaphoid fracture (which is extremely rare). Firstly, what is Carpal Tunnel? Well, this is where the nerve in the wrist (median nerve) is being pressed on by something, so there is a lot of pressure on it. The most common causes of this are underlying medial conditions, such as swelling, diabetes and high blood pressure – although trauma to the wrist is also a frequent cause. Now, carpal tunnel syndrome has some rather annoying symptoms: a weak thumb and grip, tingling in the fingers and a burning sensation in the arm, which can all contribute to an overall debilitation of the the arm, as it can be painful and made worse by overextending… Since it can be so awful for a sufferer, it tends to be treated quickly using one main surgical method, or through minor treatments. The first step of treatment is a self-help splint from a shop, but if this doesn’t help, a GP can prescribe steroid injections (eg corticosteroids) to help. However, if all this fails to help, then carpal tunnel syndrome surgery can be used… This involves a local anaesthetic to numb pain, an incision in the wrist and then the carpal tunnel cut to relieve pressure! So, as you can see, carpal tunnel syndrome is rather easy to fix, but a pain to have. So to have seen multiple cases of this in one week, makes me realise how common it is, and reveals to me how interesting it is.

The next case I saw whilst at New Cross was a scaphoid fracture. These fractures, I was told, are very rare in
occurrence. This is mainly due to the fact that they are often missed by the X-ray and fracture Doctors. Scaphoid fractures are notoriously small (hence why they are missed) but also notoriously hard to heal, hence they make for a pretty interesting case. On further research, I have found out why they are so hard healing, in that they have a really bad blood supply – a bone heals with nutrients brought by the blood. Therefore, since the scaphoid is 80% covered in cartilage, the lack of the blood to the fractured part of the scaphoid can mean that it struggles to heal properly. So, when a scaphoid fracture occurs, they can often not heal at all… Due to this lack of visibility, and lack of healing, a clinicians main ideology is to treat for a scaphoid fracture, erring on caution, and hence, the most common treatment is actually to put the hand/lower wrist in a cast. For me, this was a greatly interesting example of a Doctor using deduction and inference skills, to find the fracture.

In conclusion then, I have experienced an absolutely amazing week at New Cross shadowing the Doctors, nurses and technicians of the Fracture and Orthopaedic Clinics/Department, having seen some exemplary team work and multi-disciplinary skills. In addition, I was able to bear witness to two rather interesting problems, and many more on top of that.

Cheers, Jarred.

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