Operative Orthopaedics
EBOT - European Board for Orthopaedics and Traumatology - Board Certified
Certified by the European Board for Orthopaedics and Traumatology
Orthopedic instructions for General Practitioners
- Operative Orthopedics
Dear colleagues,
if you have any questions related to orthopedics and traumatology, feel free to contact us!
These instructions for GPs should facilitate communication with the Orthopedic surgeon specialist. In the common interest of arriving at an accurate diagnosis as quickly as possible, quick and successful treatment, and returning to work as quickly as possible, I would recommend, before coming to the Othopedic surgeon, to refer the patient to a basic radiological diagnostics. Some hospitals only provide the radiologist's reading and no recordings on film or CD (warn the patient to ask for the recordings).
If there is no significant improvement after 10 treatments with Physical therapy, I would recommend consulting an Orthopedic surgeon. After a clinical examination and adequate diagnosis, the patient will receive information about the type of disease and the optimal method of treatment, conservative or surgical. The approach to the patient is individual, because an identical diagnosis, with the same radiological findings in two patients, with different subjective complaints, different work, and lifestyle can result in a different approach to treatment of the same disease. Determination of sick leave in two patients with the same diagnosis is conditioned by the specifics of the workplace. If you have difficulties in determining sick leave, I would recommend a consultation with an Occupational medicine specialist who, guided by the specifics of the patient's workplace and specialist orthopedic findings, would recommend the optimal length of sick leave.
In case of joint pain, I would recommend doing next:
X-ray examinations
Shoulder: AP and Y scapulolateral scan (some medical radiologists do not have experience in taking a Y scan, so it would be advisable for the patient to check this, it happens that they take atypical scans that are not useful). I would recommend asking the radiology engineer to enter Y scapula lateral view radiograph on the internet where they will receive instructions on how to take the required image.
Elbow: AP, LL
Hand/wrist: AP, LL
Hip: pelvis with hips and painful hip LL
Knee: AP standing, and LL, patella (most older types of X-ray devices do not have the ability to record standing.
A standing image provides additional valuable information about cartilage damage)
Ankle: AP, LL
Foot: both feet AP standing, LL
Panoramic X-rays of the lower extremities while standing are necessary in preoperative planning for corrective knee osteotomy and in Total Knee Replacement.
After analyzing the X-ray images, it is possible to refer the patient to ultrasound diagnostics. Such an examination can be performed by a radiologist experienced in ultrasound examinations of the locomotor system or an orthopedic surgeon. After the clinical examination, the orthopedic surgeon may be able to get a better idea of the pathology of the organ being examined.
X-ray of both knees AP, left taken lying down - right standing, visible difference in joint width
Wound dressing
After the operation, the wound is bandaged regularly depending on the need (secretion, bleeding), in principle every two days for the first week, then less often. When dressing on the first postoperative day or while the secretion lasts, I would recommend avoiding alcoholic preparations because they burn. I would recommend avoiding preparations with iodine, since iodine allergy and postoperative skin infection look similar and can lead to wrong treatment.
Suture removal
After the operation, it is recommended to remove the stitches around the 14th day. Modern threads do not cause an inflammatory reaction of the skin and can stay on longer. Today, modern subcutaneous sutures are in use, which are quickly resorbed, so they do not need to be removed. The advantage of a wound sutured in this way is that the wound is very quickly watertight (thereby also impervious to bacteria). In the event that the wound opens after the removal of the sutures, a traction patch (a patch that will bring the edges of the skin closer together) is applied and removed when the wound has completely healed.
Schlofer's tumor
Rarely, after surgery and repair of damage or injury, a painless soft-elastic formation remains that can be palpated under the skin in the vicinity of a properly repaired postoperative scar. US and MR diagnostics confirm the diagnosis of Schlofer's tumor. It is a residual suture that has not been resorbed, or if it has not been resorbed completely, a larger scar and swelling is created around it. Treatment is surgical removal of whole formation. The name tumor in this case does not refer to the disease itself but to the appearance of the process, which in reality is just a scar tissue.
Under construction: Vidao clips of basic orthopedic tests that can be easily applied in the clinic of a primary care doctor.