Trauma and Orthopeadics Rotation Preparation

 Published: 14/04/2023

Updated 11/6/2023

Disclaimer: my experience is related to an Acute University Hospital trust that is also a Major Trauma Centre, but the advice is applicable to any acute setting. 

Trauma and Orthopaedics is a rotation where the therapists have a partnership with the surgeons/medical team. Therapists feedback to the surgeons to ascertain the weight-bearing status or other information to provide the best outcomes for patients. 

Important factors to be aware of

• The number of days post-op the patient is
• For fractures - the 'average' healing time will help to guide your reasoning behind the interventions you use
• For surgical patients - protocols and post-op instructions for the T&O team will guide your interventions
• Patient's home environment - this will inform your discharge planning and goals for rehabilitation from day 1 post-op
• Common conditions: 
• Minor trauma patients: Fractured neck of femur (and their fixation methods), Fracture humerus, Distal radius fracture, ankle fracture (and fixation e.g. ORIF)
• Elective surgeries: Total knee replacement, Total hip replacement, Total shoulder replacement and Reverse total shoulder replacements

Preparation advice

• Meet with the T&O team prior to rotating - ask for copies of the post-surgical protocols and generic patient exercise leaflets. Familiarise yourself with these prior to rotating
• Clinical Physio webinars - there are plenty on T&O topics and provide a great overview of post-op rehab and considerations post-surgery
• Learn/create crib card on the normal fracture healing times for lower limbs (femur, tibia/fibula, humerus and radius/ulna)
• Practice your social histories - this will be really important for your discharge planning (e.g. location of bed and toilet in the house, any stairs? etc)
• Test your knowledge with Clinical Case Studies in Physiotherapy case study questions

Additional advice

• Relax and follow the protocols, if you see anything concerning raise this to a senior
• The bed and standing exercises will become second nature over time
• Understand how to progress an exercise (e.g. Static quad -> inner range quad -> Straight leg raise)
• If you get the chance, organise an opportunity to shadow the Major Trauma team to see how physiotherapy interventions differ (Key point: know what you can't do)

Other resources

• Clinical Physio Orthopaedics Fundamentals (on-demand webinar or available on their membership site)
• Total Knee replacement exercises chrome-extension://efaidnbmnnnibpcajpcglclefindmkaj/https://www.uhs.nhs.uk/Media/UHS-website-2019/Patientinformation/Muscles,jointsandbones/Totalkneereplacementenhancedrecoveryprogramme-1982-PIL.pdf
• Total hip replacement exercises chrome-extension://efaidnbmnnnibpcajpcglclefindmkaj/https://www.uhs.nhs.uk/Media/UHS-website-2019/Patientinformation/Muscles,jointsandbones/Total-hip-replacement-enhanced-recovery-1981-PIL.pdf
• Your Trust's patient information leaflets for T&O injuries or surgeries