Orthopaedic Services

Orthopaedics services exist in order to provide high quality orthopaedic care for people with trauma and orthopaedic related problems by providing inpatient and outpatient services. 

Eight consultants specialise in specific areas of orthopaedics as well as being experienced in general orthopaedic work.

The inpatient services are provided on B26, elective ward; B24, trauma ward and B23, trauma ward.

Orthopaedic liaison service 

The Orthopaedic liaison service has been running for over 5 years, following a successful pilot project, which looked at hip replacements for one consultant.

The other orthopaedic consultants have gradually asked for our involvement and we now work for all eight. The team consists of one full time senior sister, a full-time and a part-time sister. The team has an administration clerk for 12 hours a week. There are infinite possibilities to expand to include trauma patients plus other major orthopaedic surgery patients.

Services 

Services include:

Pre-operative home visits 

• We visit the patient at home approximately one week before the pre-assessment Clinic appointment with the Consultant.

• The integrated care pathway is commenced at this point.

• A full medical history is taken and blood pressure and pulse recorded.

• The skin is checked for ulceration or infected areas. Pedal pulses are checked. Routine Blood samples are taken. Swabs are taken for MRSA and a urine sample taken.

• Medication is recorded. At this point any patients who seem unfit or inappropriate for surgery are brought to the attention of the Consultant.

• The proposed surgery is discussed and sensible coping strategies put in place for the post-operative recovery period.

• The home environment is checked to ensure it is safe for the post-operative recovery period. The bed, chair and toilet heights are measured. The side of the bath is measured if the patient has to stand in the bath to use the shower. The kitchen is checked and suggestions made to make preparing meals easier i.e. moving pans up from low cupboards.

• Prior to the commencement of the scheme, the nurses spent with both the Physiotherapists and Occupational Therapy staff to learn some basic assessment skills. Time was also spent in the various consultant clinics learning how to assess the criteria for surgery. Postoperative assessment skills were also learnt.

SOS visits

• The patients are given contact numbers for the team and the ward so they can call if they experience any post-operative problems. We provide a post-op SOS visiting service and have a fast track system in place for re-admission to hospital, to avoid long waits in A&E. We also can expedite clinic appointments if we feel the patient needs immediate review.

• We also accept requests from the local GPs who quite often seek our opinion. The team now provides support at home for patients with minor wound healing problems so this should not delay discharge home.

• The team will visit patients who are on the waiting list for surgery but experiencing difficulties, to assess their symptoms, offer advice and report back to the Consultants.

Orthopaedic appliances

• A follow-up service is provided for patients in hip hinges. Skin care is given and brace liners are changed on a regular basis depending on skin condition. Advice is given to district nurses and GPs re care. We accept referrals from any source.

Six week post-operative follow-up visit

At this point we will visit you at home to complete an assessment form. The areas covered are:

• Circulation oedema/ DVT

• Wound well healed/ inflammation/ heat signs of infection

• Mobility exercises/ walking aids, gait, range of movement, distance (compared to pre-op), weight bearing,
  Muscle tone

• Home circumstances and ability to cope with daily activities

• Pain controlled site and type, analgesia required

• Mental status- well adjusted /depressed /pleased with progress

• Advice given- driving, sleeping on side, etc sensible goals for next 6 weeks

Hip and knee club 

• We run a waiting list group for patients who have problems with hips and knees. The patients are invited to attend a session after they have been on the list about 3 - 4 months.

• They can have a guided tour of the ward, and meet other joint replacement patients who have had their surgery. Some a few days post-op others fully recovered and back to good mobility.

• We give a brief session on what the joint replacements look like and what to expect from the new joint. If there are any tests that you need prior to your operation we can arrange for them to be done at this appointment. The nurses will examine you to make sure you are fit to have your operation. It is really important where possible that you have no unhealed leg ulcers or infected toenails as these will delay your surgery due to the risk of infection.

• The physiotherapists give out the exercise sheets and encourage the patients to try to strengthen their muscles before they are admitted. The nurses suggest what equipment and aids might be of use.

Spinal support group

• We run a support group on a monthly basis for patients awaiting spinal surgery.

• The aim of these sessions give patients as much information as we can regarding their journey so far and what they can realistically expect following their surgery.

• Our chronic pain nurse specialist talks to them about chronic pain and how it can affect their lives.

• The physiotherapist gives them some information regarding what they should be able to do following surgery and what they must not do. She also discusses the importance of posture and muscle control.

• We give the patient an idea of what to expect during their admission to the ward and also about the liaison nurse visit to their house before and after their surgery.

• The meeting concludes with a discussion session when we endeavour to answer questions that may be concerning the patient. 

Bone bank 

• The nurses in the Liaison scheme are responsible for recruiting hip replacement patients to donate their bone at the time of their operation. They have been trained to explain how the process happens and what tests are involved. The potential donor has to give their consent both to donate their bone but also for an HIV or AIDS test. We co-ordinate the results and organise the 6 month post-op follow-up appointments for blood tests.(HIV/AIDS) This involves giving sufficient information to obtain true informed consent.

Pre-assessment blood / swab results

• All the results are sent to our office so they are checked and any referrals made or treatment commenced. Any unfit patients are referred to anaesthetic clinic or to the medics. If you need any treatment before your operation we will contact you.