Prioritisation 1
You have 10 minutes to complete the following scenario.
Scenario
You are the ST3 at the MTC. You have come in at 7am to plan the list for the day.
You have a 2 theatre session list.
All patients are marked and consented.
55YO F | Fall onto outstretched hand, sustained a Distal radius fracture |
30YO M | 2 day history of swollen red hot knee |
45YO F | Fall, sustained a midshaft tibial fracture |
8YO M | Both bone forearm fracture, son of anaesthetist |
12YO | Supracondylar fracture |
Location MTC
II available 2 session list. No extra theatres. No separate paeds list
Consultant happy to do anything
COVID -ve, MRSA -ve
Kit available
No allergies
| 55YO F, Fall onto outstretched hand, sustained a Distal radius fracture | |
| Isolated injury? | Trauma call/ATLS |
| Intra/Extra articular? | Intra (72 hours to operate), Extra (1 week) |
| When did the injury occur? | Intra (72 hours to operate), Extra (1 week) |
| Attempt at reduction in ED? | If re-displaced time to operate 72 hours |
| Closed injury? | Open needs 12-24 hours operation unless agricultural/sewage/aquatic. |
| NV intact? | 4 hours revascularisation/urgent reduction if nerves |
| Any significant co-morbidities? | Anticoagulation etc. |
| In a backslab currently? | |
| 30YO M. 2 day history of swollen red hot knee | |
| Native vs Prosthetic | Aspiration on ward |
| Cultures taken? Including joint aspirate? | Immediate start to Abx |
| Is the patient septic? BP/Temp/RR/O2/HR | Urgency |
| Any significant co-morbidities? | Diabetic, IVDU, anticoagulation |
| On Abx?/fluid recussitated? | |
| 45YO F. Fall, sustained a midshaft tibial fracture | |
| Isolated injury? | Trauma call/ATLS |
| Closed injury? | If open treat as per BOAST |
| If open ? contaminant | Agricultural/aquatic/sewage – urgent operation 12 hours for high energy 24 for low energy |
| NV intact? | |
| Compartment syndrome? | 1 hour to operate with compartment syndrome |
| In an above knee backslab?/X-Ray post reduction? | Post reduction X-Rays required |
| Any significant co-morbidities | |
| 8YO M. Both bone forearm fracture, son of anaesthetist | |
| Isolated injury | Yes/no |
| NAI | |
| Closed? | If open treat as per BOAST |
| NV intact? | Urgent if symptoms/split cast |
| Attempted reduction?/X-Ray | Should be attempted in A+E if policy |
| In backslab? | Above elbow backslab |
| Degree of reduction? | As less than 10 <45 deg rotation, <15 deg angulation, 1cm shortening |
| 12YO. Supracondylar fracture | |
| Isolated injury | |
| NAI | |
| Closed? | Open/impending open urgent surgery |
| NV intact? | ?AIN ? Median ? radial ? ulnar Pale/pulseless overnight surgery |
| In backslab? | |
55YO F | Fall onto outstretched hand, sustained a Distal radius fracture – Intrarticular – Closed – NV intact – In backslab |
30YO M | 2 day history of swollen red hot knee – Septic – Native – Aspirate taken |
45YO F | Fall, sustained a midshaft tibial fracture – Open injury – No contamination with agricultural, aquatic, sewage material – Isolated injury |
8YO M | Both bone forearm fracture, son of anaesthetist – 30 rotation, 10 degrees displacement, no shortening – No NAI |
12YO | Supracondylar fracture – Pulseless + Pink – No nervous compromise |
CEPOD overnight
- 30YO male with septic knee (lifethreatening)
Theatre in morning
- 12YO supracondylar fracture (Child/BOAST guidelines dictate early management)
- 45YO open fracture – IF CEPOD available in the morning to be done there (BOAST, do in separate theatre to keep theatre clean)
- 55YO distal radius (Least urgent case requiring surgery)
No need for operation
- 8 YO both bone forearm
- Should have his images reviewed by consultant within 72 hours and fracture clinic appointment within 7 days.
