16 - Orthopaedic surgery

Summary

Introduction

The broad field of orthopaedic surgery can be divided into elective orthopaedics and emergency (trauma) orthopaedics. In elective orthopaedics, there are two major subcategories, namely arthroscopic surgery and joint replacement surgery.

General factors related to orthopaedic surgery

Clothing in the operating theatre (see also Chapter 3, p. 11)

In orthopaedic surgery, and in particular in joint replacement surgery, most surgeons expect that any person entering the operating theatre covers all their hair. This is usually done with a balaclava-type head cover. Sometimes ‘space suits’ are used; these are all-enclosing suits and helmets with an air supply pumped into them, designed to seal all the air circulating around the body of the surgeon and assistant. Eye protection should always be used, as orthopaedic surgery can be quite bloody.

Marking the operation site (see also p. 21)

Because most orthopaedic operations are on the limbs, wrong-sided surgery is a major concern to orthopaedic surgeons. The ultimate responsibility for correct-sided surgery rests with the surgeon. However, this does not mean that the surgeon is the only member of the surgical team who is required to check which side is to be operated on. Indeed, the entire surgical team, including nursing staff, anaesthetist and you, the assistant, should be vigilant in this task. This may include checking that the patient, pre-operative notes and consent form all agree on which side is to be operated on, and checking that the patient has had a mark (e.g. an ink arrow) either prior to the entry to the theatre, or on entry into the theatre.