Orthopedics is one of the busiest services in the healthcare industry. And while those of you working in an Orthopedic service line don't need statistics to tell you how busy you are, we're going to highlight a couple of them anyway:
In the US, nearly 7 million Orthopedic Surgeries are performed each year (source). Globally, Orthopedic Surgeries reached an estimated 28.3 million in 2022 (source). Orthopedics is definitely a service line that is busy, and it only seems to be getting busier!
In today's Top 10, we're going to talk about Orthopedic Surgery, and go beyond the bones to talk about the items that are common to Orthopedics, regardless of the subspecialty. Yes, we could get incredibly specific based on sports medicine, total joints, Ortho trauma, etc. But, there are some things that are just universal to Orthopedics, and those foundational items are the ones we're going to address today.
So, what do you need to know about Orthopedic Surgery?
Nerve blocks are very common in Orthopedic Surgery. They decrease pain during and after surgery for our patients, and they are more effective at controlling pain than IV or oral medications alone. Nerve blocks can also allow for patients to have their operation without being fully asleep - they'll be sleeping, but won't be intubated, and they will be able to talk to you and hear you (so be careful what you say!) But, being able to recover from a "lighter" dose of anesthesia medications and having longer pain control from their nerve block allows patients to recover faster and go home sooner.
Have all radiologic exams (XRays, CT scans, MRI) ready to go before the surgery begins. The surgeon will generally want to review them when they come into the room, so have them ready!
Be prepared to have additional imaging taken as well. Depending on your facility, Radiology may have Technologists staffed in the OR on busy Orthopedic days, or you may have to call them when you roll into the room. So make sure you know your facility's policy, and know Radiology's number. And, if you're going to be taking an x-rays, make sure you have lead available for your protection!
Laterality is important! Many times in Orthopedics, we're dealing with limbs, and most of our patients, although certainly not all of them, have two arms and two legs, so make sure you confirm laterality (with the patient and compare with the consent) and visualize the site marking to avoid any disastrous mistakes!
Know your grafts - Allograft or Autograft? Also, what is your facility's policy for retrieving them from the implant room and documenting them correctly? Allograft is tissue taken from another person, or donor. Autograft is tissue that is taken from the patient's own body.
Implants! There's more than just grafts - we've got plates, pins, screws, nails, and artificial joints, just to name a few. You must make sure that you have the proper trays in the room for the case that you're doing, and know who the vendor representatives are for your cases. Many of their trays are brought in specifically for cases, and they're the experts on those trays. You also have to make sure that what is used out of the implant trays is accurately documented in your patient's chart. Was the item implanted? Implanted but removed? Not used? Always confirm your implant record and your charting to make sure that all implant charges are correct.
Labs are important! What is your patient's potassium level? If they're female and of childbearing age, what is the result of their urine pregnancy test? What is your patient's hemoglobin and hematocrit? If it's low, you might need blood. Additionally, has a Type & Screen been done, or a Type & Cross? If the patient has only been screened, a transfusion isn't certain. If a crossmatch has been done, chances are you're going to be giving blood to the patient. Any lab value that is out of range can be concerning, and should be discussed with the team before rolling back for surgery.
Know your patient's allergies. We will use antibiotics in irrigation during procedures, we will give injections while patients are asleep, and it's easy to forget when we get into our routine and pour our usual medications onto the backtable that that our patient might have an allergy and we need to confirm.
Did someone say Hana Table? Oh, it's the dreaded table of Orthopedic Surgery! But, it's not the only one! We have so many specialty tables, and you have to be proficient at using each of them safely so that your patients are always positioned safely and you don't injure yourself while using it.
It's not just beds, either. We've got bed accessories for days, don't we? We've got bean bags, fishing poles, peg boards, arm boards, radiolucent endpieces (diving boards), hand tables, leg holders... the list seems infinite. However, know the equipment that your surgeon needs, and don't be afraid to ask how to use it so that you are using it safely.
Well, we couldn't stop at 10, so you get one more for free! Top 10 just sounds better than Top 11...
11. Orthopedics uses so many different types of dressings and other accessories - know what you're going to need for your cases and have the ready at the end of the case. From Ace wraps to plaster casts, from post-op shoes to walking boots and every other possibility in-between, we've got a dressing, sling, cast, or boot that works for your patient's case. So be prepared!
Well, there you have it! A starting point of 11 different things that will help set you up for success in Orthopedics. However, no list is as thorough as in-person training with your Ortho service-line coordinator or team lead, so don't be afraid to ask for education or training on any of the equipment, processes, or specifics that you aren't comfortable with. All of us in leadership would rather you ask for extra training than for you to try on your own and hurt yourself or your patient.
Orthopedics isn't as scary or overwhelming as it may seem at first. Sure, there's a learning curve, but once you master it, you'll find that it's an incredibly exciting specialty to work in!
Until next time,
Lindsey & Melanie