Station Guide

This station is out of 50 with 10 point (5 points from each assessor) available in each of the following domains:

  • Organisation and Planning
  • Judgement under Pressure
  • Situational awareness
  • Problem solving and decision making
  • Information gathering

We would recommend the following technique when approaching this scenario:

  • We recommend using the following opener before moving onto cases (LICCKA)
    • Location (DGH vs MTC)
    • II available and how many theatres/elective theatres
    • Consultant (General, hip etc are there any cases they are not comfortable performing)
    • COVID/MRSA
    • Kit available?
    • Allergies (latex or Chlorhexidine)
  • Following this we would deliver and collect information at the same time. When collecting information state how that influences management e.g. open fracture is it contaminated/high energy/low energy? Low energy requires debridement in 24 hours.
  • Mention BOAST and NICE guidelines where relevant

Below are a few key points to consider for different injury types

Injury type

Points to consider

Dislocation with peripheral nerve injury

Immediate

Stabilisation of unstable fracture with associated nerve injury.

Immediately as soon as safe

Distal radius (intra-articular)

72h from injury

Distal radius (extra-articular)

1 week

Distal radius displacement following manipulation

72h from decision to operate

Ankle fracture

Day of or after injury if swelling allows. If swelling doesn’t/unstable then ex-fix

Fracture related infections (following recent fixation before healing)

If well – 48h for consultant review

If septic – immediate (give Abx)

Supracondylar fracture

(day of or day after injury)

Pale and pulseless – immediate

Open/threatened – immediate

Pulseless + pink – consultant decision

Damage control ortho

Only life threatening injuries

  • Unstable pelvic #
  • Compartment syndrome
  • # with vascular injuries
  • Unreduced dislocations
  • Traumatic amputations
  • Unstable spine #
  • CES
  • Open #

Unless

  • Lactate < 4 mmol/L
  • pH >7.25
  • Base excess > 5.5mmol/L

Open fractures

IV Abx within 1 hour

Debridement using fasciotomy lines

  • Immediately for highly contaminated/vascular injury/compartment (agricultural, sewage, aquatic)
  • 12 hours of injury for solitary high energy open fractures
  • 24 hours for low energy open fractures

Definitive soft tissue within 72h

Vascular injury

Ischaemic limb should be revascularized within 4 hours

Consider fasciotomy

Paeds both bone forearm #

<10YO Angulation <15deg rotation 45 1cm short

>10 angulation <10 rotation <30 no shorting

2 years from skeletal maturity 0 tolerance

Immediate reduction should be performed if set up available.

Compartment syndrome

1 hour from decision to operate

All patients should undergo re-exploration at approx. 48 hours

Pelvic fractures

IV TXA within 1 hour

Major haemorrhage

Pelvic binder removed ideally within 24 hours

EX fix when early definitive treatment not possible

MTC within 24 hours

Reconstruction should occur within 72 hours

Elderly Neck of femurs

Comprehensive geriatric assessment within 72h

Pain management

Bone health review

Nutritional assessment

Falls assessment

Surgery within 36 hours

Mention NICE

THR if:

  • 1 stick
  • Of sound mind
  • Able to survive anaesthesia
Please log in to join the chat