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Starting Strong in T rauma and Orthopaedics: A Guide for Aspiring Arthr opods Siddarth Raj MBBS BSc (Hons) MRCS (Eng) PGCert (Med Ed) siddraj@doctors.org.ukiear 2 (CT2) Core Surgical TContent • An overview of T rauma and Orthopaedics (T&O) in the NHS Thinking about key conditions in T&O • • How to prepare for a career in T&OContent • An overview of T rauma and Orthopaedics (T&O) in the NHS Thinking about key conditions in T&O • • How to prepare for a career in T&OT rauma & Orthopaedics in the NHS • One of the largest specialities in the UK National Health Service (NHS) https://digital.nhs.uk/data-and-information/publications/statistical/hospital-outpatient-activity/2021-22/summary-reportT rauma & Orthopaedics in the NHS 1. Trauma Management of acute fractures and • emergencies 2. Orthopaedics • Elective procedures e.g. joint replacements and deformity corrections https://ota.org/for-patients/find-info-body-part/3720T rauma & Orthopaedics in the NHS • Patients in primary , secondary and tertiary care https://pubmed.ncbi.nlm.nih.gov/35747902/T rauma & Orthopaedics in the NHS • A truly multidisciplinary speciality • Anaesthetists • Intensivists (ICU/ITU) • Nurses • Physiotherapists • Plaster room technicians • Primary care • Radiologists https://medicalschoolexpert.co.uk/what-is-a-multidisciplinary-team/Content • An overview of T rauma and Orthopaedics (T&O) in the NHS ✅ • Thinking about key conditions in T&O • How to prepare for a career in T&OKey Conditions in T&O • Predominant focus on trauma • Exposure to orthopaedic sub-specialities while in training https://www.boa.ac.uk/careers-in-t-o/how-long-does-it-take-to-train-as-a-t-o-surgeon/specialties-in-orthopaedics.htmlCase-based discussionsSpot Diagnosis https://www.amboss.com/us/knowledge/hip-fracturesRelevance of Hip Fractur es (UK) https://www.nhfd.co.uk/2024reportNeck of Femur https://www.researchgate.net/figure/Drawing-shows-the-vascular-supply-of-the-femoral-head-The-main-contribution-to-the_fig2_321040810Neck of Femur https://www.researchgate.net/figure/Drawing-shows-the-vascular-supply-of-the-femoral-head-The-main-contribution-to-the_fig2_321040810Neck of Femur More so in children https://www.researchgate.net/figure/Drawing-shows-the-vascular-supply-of-the-femoral-head-The-main-contribution-to-the_fig2_321040810Hip Fractur e Guidelines • Developed by NICE • Ultimately comes down to fracture pattern: • Intracapsular versus extracapsular https://www.nice.org.uk/guidance/cg124/resources/hip-fracture-management-pdf-35109449902789Neck of Femur https://www.amboss.com/us/knowledge/hip-fracturesNeck of Femur • Intracapsular fractures occur proximal to the point at which the hip joint capsule attaches to the femur .  • Extracapsular fractures occur distal to the hip joint capsule.  https://www.amboss.com/us/knowledge/hip-fracturesNeck of Femur https://www.amboss.com/us/knowledge/hip-fracturesNeck of Femur https://en.wikipedia.org/wiki/Hip_fracture#cite_note-17Intracapsular https://www.amboss.com/us/knowledge/hip-fracturesIntracapsular https://www.magonlinelibrary.com/doi/abs/10.12968/hmed.2020.0215Intracapsular https://www.magonlinelibrary.com/doi/abs/10.12968/hmed.2020.0215Intracapsular http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S1681-150X2020000200009Intracapsular http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S1681-150X2020000200009Spot Diagnosis https://www.researchgate.net/figure/Reverse-obliquity-intertrochanteric-fracture-AO-OTA-31-A3-fracture_fig6_334222554Neck of Femur https://www.amboss.com/us/knowledge/hip-fracturesExtracapsular https://www.magonlinelibrary.com/doi/abs/10.12968/hmed.2020.0215Extracapsular ttps://www.amboss.com/us/knowledge/hip-fracturesExtracapsular https://www.researchgate.net/figure/mplants-for-the-screw-group-a-Dynamic-hip-system-DHS-screw-b-Gamma-nail_fig1_50349282Neck of Femur Fractur e - Summary https://link.springer.com/chapter/10.1007/978-3-030-48126-1_9Spot Diagnosis • A 71-year-old woman comes to A&E after a fall onto her right knee. She describes pain on outside of the right leg. She is able to weight bear , however without dorsiflexing her foot. Which nerve is most likely affected? A. Femoral nerve B. Sciatic nerve C. Common peroneal nerve D. Tibial nerve E. Posterior femoral cutaneous nerve https://makeagif.com/gif/right-foot-drop-in-ambulating-patient-xwKkghSpot Diagnosis • A 71-year-old woman comes to A&E after a fall onto her right knee. She describes pain on outside of the right leg. She is able to weight bear , however without dorsiflexing her foot. Which nerve is most likely affected? A. Femoral nerve B. Sciatic nerve C. Common peroneal nerve D. Tibial nerve E. Posterior femoral cutaneous nerve https://makeagif.com/gif/right-foot-drop-in-ambulating-patient-xwKkghSpot Diagnosis • A 71-year-old woman comes to A&E after a fall onto her right knee. She describes pain on outside of the right leg. She is able to weight bear , however without dorsiflexing her foot. Which nerve is most likely affected? A. Femoral nerve B. Sciatic nerve C. Common peroneal nerve D. Tibial nerve E. Posterior femoral cutaneous nerve https://makeagif.com/gif/right-foot-drop-in-ambulating-patient-xwKkghImportance of Anatomy https://www.mountsinai.org/health-library/diseases-conditions/common-peroneal-nerve-dysfunctionFoot Dr op • As a result of weakness of the foot dorsiflexors (Tib ant., EHL and EDL) • Causes of foot drop: • Most common: common peroneal nerve palsy • L5 radiculopathy • Sciatic nerve lesion • Superficial or deep peroneal nerve lesion • Stroke (with other signs and symptoms) • Overall, worth knowing the course of nerves and where possible injuries can occur .Importance of Anatomy https://www.mountsinai.org/health-library/diseases-conditions/common-peroneal-nerve-dysfunctionImportance of Anatomy Sciatic Nerve https://www.mountsinai.org/health-library/diseases-conditions/common-peroneal-nerve-dysfunctionImportance of Anatomy Sciatic Nerve Tibial Nerve https://www.mountsinai.org/health-library/diseases-conditions/common-peroneal-nerve-dysfunctionSpot Diagnosis • An 18-year-old man is stabbed on his left buttock and presents to A&E, where the wound is sutured. Two weeks after this incident, he attends the Orthopaedic outpatient clinic with a waddling gait. On inspection, he has wasting of his buttock muscles. On examination, he has difficulty abducting his thigh. Which nerve is most likely to have been injured? A. Superior gluteal nerve B. Obturator nerve C. Sciatic nerve D. Femoral nerve E. Inferior gluteal nerve https://makeagif.com/gif/trendelenburg-gait-demonstration-kukmLbSpot Diagnosis • An 18-year-old man is stabbed on his left buttock and presents to A&E, where the wound is sutured. Two weeks after this incident, he attends the Orthopaedic outpatient clinic with a waddling gait. On inspection, he has wasting of his buttock muscles. On examination, he has difficulty abducting his thigh. Which nerve is most likely to have been injured? A. Superior gluteal nerve B. Obturator nerve C. Sciatic nerve D. Femoral nerve E. Inferior gluteal nerve https://makeagif.com/gif/trendelenburg-gait-demonstration-kukmLbSpot Diagnosis • An 18-year-old man is stabbed on his left buttock and presents to A&E, where the wound is sutured. Two weeks after this incident, he attends the Orthopaedic outpatient clinic with a waddling gait. On inspection, he has wasting of his buttock muscles. On examination, he has difficulty abducting his thigh. Which nerve is most likely to have been injured? A. Superior gluteal nerve B. Obturator nerve C. Sciatic nerve D. Femoral nerve E. Inferior gluteal nerve https://makeagif.com/gif/trendelenburg-gait-demonstration-kukmLbGluteal Region • Muscles: gluteus maximus, gluteus medius, gluteus minimus (and tensor fascia lata) • Innervation: • Superior gluteal nerve (L5, S1) -> gluteus medius and minimus (and tensor fascia lata) • Inferior gluteal nerve (L5, S1 and S2 nerve roots) -> gluteus maximus https://teachmeanatomy.info/lower-limb/muscles/gluteal-region/W addling Gait • AKA T rendelenburg gait • Pelvis drops on unaffected side • Trendelenburg sign https://stanfordmedicine25.stanford.edu/the25/gait.htmlKey Conditions in T&O • Predominant focus on trauma - please read up on: General Trauma/ Emergencies Lower Limb Upper Limb Others Major trauma Hip and femur Clavicle fractures Septic arthritis e.g. open fractures fractures Compartment Shoulder dislocations Cauda equine syndrome Tibial/fibular fractureand humeral fractures syndrome Paediatric fractures Necrotising fasciitis Foot and ankle Wrist fractures e.g. e.g. supracondylar fractures/injuries distal radius fracturesContent • An overview of T rauma and Orthopaedics (T&O) in the NHS ✅ • Thinking about key conditions in T&O ✅ • How to prepare for a career in T&OA car eer in T&O (in the UK) • For new graduates i.e. those who have not completed PG surgical training surgery https://thesavvyimg.co.uk/orthopaedic-surgery-guide-uk/A car eer in T&O (in the UK) • For new graduates i.e. those who have not completed PG surgical training surgery • Other routes • e.g. CREHST https://thesavvyimg.co.uk/orthopaedic-surgery-guide-uk/Preparation - Foundation Pr ogramme •Foundation programme applications https://foundationprogramme.nhs.uk/Core Sur gical T raining and Higher Sur gical T raining • Constantly changing! • Strategy: Read through both - be efficient! • Principles • Surgical evidence: eLogbook • Academic: presentations and publications • Audits: closed-loop audits i.e. 2 cycles Higher degrees • • Leadership • Teaching CST and ST3Example • Medical school Y1-2: Pre-clinical sciences • • Y3: Intercalate* in a relevant degree • Y4-6: Clinical sciences; SSCs; electives; prizes • Notes • Develop eLogbook • Develop clinical, academic, leadership and teaching skillsExample • Foundation programme • F1: Settle in; MRCS Part A; courses (e.g. BSS); conferences; audits; teaching • F2: Be a safe SHO; MRCS Part B; courses (e.g. A TLS); PGCert; apply for CST • Core surgical training • CT1: Settle in; get comfortable on-call, in clinic and in theatre • CT2: Start to think like a registrar; apply for ST3 • Tip: structure interview answers: CAMP; SPIES; ST ARSummary • Plenty of routes • Plenty of opportunities • Just need to be proactive https://www.fpaprep.com/blog/plans-are-nothingContent • An overview of T rauma and Orthopaedics (T&O) in the NHS ✅ • Thinking about key conditions in T&O ✅ How to prepare for a career in T&O ✅ • Starting Strong in T rauma and Orthopaedics: A Guide for Aspiring Arthr opods Siddarth Raj MBBS BSc (Hons) MRCS (Eng) PGCert (Med Ed) siddraj@doctors.org.ukiear 2 (CT2) Core Surgical T