Complex Patient Management

When should medical imaging be undertaken?

• If clinical diagnosis is uncertain

• When treatment has failed

• Red flags

• Guide management

Systematic Approach of an X-ray/Plain radiography

1. Check patients details → name, side of body, date of xray

2. Consider clinical info → why do they require an x-ray?

3. Look at all images available → more than one view/compare

4. Bone and joint alignment → subluxation, dislocation, fracture

5. Bone cortex, texture & cortical outline → cortex = whiter

6. Joint spacing → degeneration

7. Soft tissue structures → swelling, joint effusion, myositis ossificans

ABCS → Alignment, Bone, Cartilage, Soft tissue

Advantages & Disadvantages of Computed Tomography (CT)

Advantages:

• Evaluation of bone and calcification

• Can be reconstructed into 3D images

Disadvantages:

• High amount of radiation

• poor differentiation of soft tissues (muscle vs fat)

• Limited ability to detect bone infiltration

Advantages & Disadvantages of Magnetic Resonance Imaging (MRI)

Advantages:

• Avoids radiation

• Excellence differentiation between tissue types

• Useful for identifying red flags

Disadvantages:

• Limitation apply to strong magnetic fields (e.g. metals)

• Highly sensitive by not always specific

T1 Images → Hyperintensity with FAT

T2 images → Hyperextensibility with WATER and FAT

Contrast images → gadolinium contrast highlights tears

What are 7 core problems within a complex patient?

1. Pain

2. Muscle strength and ROM

3. Balance

4. Muscle length

5. Decreased exercise tolerance

6. Neurological

7. Mental health

What is the AOOTA Classification? (classify orthopaedic fractures and dislocations)

• Bone Code (1 digit) – Identifies the bone:

  • 1 = Humerus

  • 2 = Radius/Ulna

  • 3 = Femur

  • 4 = Tibia/Fibula

  • 5 = Hand

  • 6 = Foot

  • 7 = Spine

• Segment Code (1 digit) – Identifies bone segment:

  • 1 = Proximal

  • 2 = Diaphysis (mid)

  • 3 = Distal

• Fracture Type (letter) – Indicates complexity:

  • A = Simple (extra-articular)

  • B = Wedge

  • C = Multi-fragmentary

What are the 4 main causes of fractures?

Traumatic, pathological (disease), periprosthetic (mechanical weakness), avulsion (pulling)

Why is fracture classification important?

Ensures standardisation, consistent description, and reflects severity

What are the components of the AO/OTA alphanumeric code?

Bone → Location → Type → Group → Subgroup → Qualifications → Universal modifiers

What are the simple fracture groups?

Spiral, Oblique and Transverse

What defines a wedge fracture?

a triangular piece of bone is created, usually because the bone has been compressed from one side; wedge may be intact or fragmentary

What defines a Multi-fragmentary fracture?

Many fracture lines and fragments; previously called “complex.”

What are the three end‑segment fracture types?

Extra‑articular (A), Partial articular (B), Complete articular (C)

What is the difference between open and closed fractures?

Open fractures communicate with the external environment (e.g. femur poking through the skin)

What is an incomplete fracture?

Cortex not fully broken; includes greenstick, torus, buckle.

6 types of bone alignment

What is a scaphoid fracture?

What is a Colles fracture?

What is a Monteggia fracture?

What is a Jones fracture?

SF- FOOSH, most common

Colles - Distal radius fracture with dorsal displacement and angulation

Monteggia - Proximal ulna fracture + radial head dislocation

Jones - Fracture of the 5th metatarsal diaphysis

What is a Weber A fracture?

What is a Weber B fracture?

What is a Weber C fracture?

Weber A - Below syndesmosis; usually stable

Weber B - At level of syndesmosis; variable stability

Weber C - Above syndesmosis; unstable; requires ‘ORIF’

What is a Lisfranc injury?

Lisfranc - crush injury, gap between 1st & 2nd prox. MT heads

What are the three hip fracture regions?

Subcapital (intracapsular), intertrochanteric, subtrochanteric

Garden Classification System - 1 to 4

1 → best outcome, bone ends are impacted into one another

2 → less stable, minimal displacement, anatomically normal position

3 → complete fracture, partial displacement

4 → complete fracture with total displacement, bones are separated

When is an ankle X‑ray required (Ottawa Rules)? Mz Bt Wb

• Pain in malleolar zone

• Bony tenderness (medial/lateral)

• Inability to weight bear

When is a knee X‑ray required (Ottawa Rules)?

• Age ≥55

• Inability to bear weight

• Inability to flex to 90°

• Patella or fibular head tenderness

When is a foot X‑ray required (Ottawa Rules)?

• Pain in midfoot

• Tenderness at base of 5th MT or navicular

• Inability to weight bear.
  

How are dislocations coded in AO/OTA?

Distal bone number + “0” + region letter + [direction modifier]

What must always be checked after a dislocation?

Neurovascular status + post‑reduction x-rays

What is a Salter‑Harris II fracture?

Fracture through the growth plate of a child’s bone

What are the 6 core cardiorespiratory problems?

1. Respiratory failure

2. Increased work of breathing

3. Sputum retention

4. Loss of volume

5. Pain

6. Decreased exercise tolerance

What are the steps of the clinical reasoning cycle?

P C P P G A E R

Consider patient → Collect cues → Process info → Identify problems → Establish goals → Take action → Evaluate → Reflect

What information is essential in a pre‑op assessment?

• Presenting condition

• PMHx

• Social & functional history

• Investigations

• Planned procedure

• Special orders

• Baseline respiratory status

• Pain

What does the pre‑op physical assessment include?

• Observation

• Palpation

• Auscultation

• Cough

• LL assessment

• Special tests

What should be taught pre‑operatively?

Breathing exercises, circulation exercises, supported cough, bed mobility, transfers, post‑op exercises

What subjective info is gathered post‑op?

• Pain

• Cough

• Shortness of breath

• PMHx

• Smoking

• Social/functional history

• Nausea

• Dizziness

• Drowsiness

• P&N/numbness

What must be documented post‑treatment?

• Distance mobilised

• Assistance level

• Tolerance

• Effect

• Adverse events

What problems does physio treat in ortho patients?

• Pain

• Decreased strength/ROM

• Balance issues

• Decreased muscle length

• Decreased exercise tolerance

• Neurological issues

What to look for in a pre-screening of a respiratory assessment?

Cough – Effective? Productive?

Observe RR – Work of breathing

Normal bi-basal expansion

Auscultation - Normal breath sounds

What to look for in a pre-screening of a circulatory assessment - DVT (5)

Commonly seen in the calf and assessed by looking for:

• Swelling of the calf

• Redness of the calf

• Localised pain/tenderness

• Increased temperature on palpation

• Positive Homan’s sign (calf pain on passive ankle dorsiflexion

What are the 4 cardinal signs of Orthopaedic Musculoskeletal Assessment? M R S B

1. Mobility Level (Independence)

2. Range of motion

3. Muscle Strength

4. Balance

What are the 3 mobility classifications?

1. Assistance (hands-on)

2. Supervision (verbal cues only)

3. Independent

What are the 6 Signs and Symptoms: Post-surgical chest infection

1. SpO₂ <90% after 2 days

2. X-ray findings

3. Temp >38°C after day 1

4. Productive sputum

5. Abnormal auscultation

6. Increased white cell count

What are 3 common post‑op respiratory complications?

Atelectasis (reduced PaO2, FRC, lung compliance)

Chest infection

Hypoxemia

2 types of atelectasis?

Obstructive

• Bronchial obstruction occurs and there is progressive collapse of the airways distal to the obstruction.

Non-Obstructive

• Compressive (surgery; tumor; pneumothorax; hemothorax; abdominal content weight; pleural effusion)

• Passive (loss of negative pressure in pleural space)

• Adhesive (loss of pulmonary surfactant)

• Cicatrizing (wound that leads to scarring).

What reduces mucociliary clearance?

• Medications

• Dehydration

• High FiO2

• Decreased cough

• Pollutants

What are the routes of pain relief?

Slower Acting

• Oral (paracetamol, tramadol)

• Subcutaneous narcotic (morphine)

• Intramuscular narcotic (morphine)

Faster Acting

• Intravenous - (morphine, fentanyl)

Continuous Acting

• Epidural (ropivocaine, fentanyl)

• Nerve Block - continuous infusion or local infiltration in theatre

Patient Controlled - Intermittent

• Patient Controlled Analgesia - PCA

Operative Anaesthetic

• Spinal (wears off 3-4 hours post surgery)

• General (associated with respiratory complications - atelectasis…)

Intensive Therapy Unit (sedatives)

Neuromuscular blocking agents

Time to action (5-30minutes) - plan your treatment times around this where possible

What is the physio approach to decreased exercise tolerance?

• Early mobilisation

• Sit out of bed

• Short walks

• Self‑care

• Exercise testing

• Aerobic/anaerobic/strength training

Operation Type - Total Hip Replacement, Prosthesis & Management

Most commonly used prosthesis:

• Metal on polyethylene – ball is metal, socket is plastic or plastic lined (polyethylene)

• Ceramic on polyethylene – ball is ceramic, socket is plastic or plastic lined (polyethylene)

• Ceramic on ceramic - ball is ceramic, socket is ceramic lined

• Ceramic on metal - ball is ceramic, socket is metal lined

Day 0 → hip ROM, bridging, bed mobility

Day 1 → mobilize out of bed, rollator

Day 2 → sitting 30 mins initially depending on symptoms

THR - 2 approaches + their advantages/disadvantages

Posterior - Most common, easiest for surgeon

• dislocating position - flex more than 90, FADIR

Anterior + Anterolateral - more difficult for surgeon,

• dislocating position - forced extension + ADDER

Complications → sciatic nerve damage, DVT, re-dislocation, infection, loosening of components

Operation Type - Birmingham Hip Resurfacing

• All-metal bearing couple is used to preserve, rather than replace, a patient’s femoral head and neck

• Goals: indep. mobility, home exercise program, stairs & car

Operation Type - Arthroscopic Knee Surgery

Performed through small portals to allow an irrigation cannula, a fibre optic viewer and light source, and surgical instruments into the joint.

Meniscectomy: meniscus removed (partially or total)

Meniscal repair: only if located in periphery of meniscus as adequate blood supply for healing

Chondroplasty: removal or repair/smoothing of cartilage

Ligament repair and replacement: e.g. Anterior Cruciate Ligament reconstruction

Arthroscopic Knee Surgery - 3-way patella realignment

Tibial tuberosity transfer

• Removing the tibial tuberosity medially

Lateral release

• Releases tight lat. retinaculum + vastus lateralis

Medial Plication

• folding/tucking/tightening of medial structures

Operation Type - High tibial osteotomy (knee)

Proximal part of the tibia is cut and realigned to change how weight is distributed through the joint.

Factors: under 65, not overweight, 90deg flexion, non-smoker, higher activity level

Total Hip Replacement - Post Op. Management

Day 0 or 1 - hip ROM, quad exercises, bridging, bed mobility as aim, get out of bed on un-affected side

Day 1 Sitting - 30 minutes initially

Day 2 - progress ROM/strength, balance exercises, stairs, car transfers

Operative Type - Total Knee Replacement

Femoral and tibial metal component with a polyethylene spacer

• Gold standard for OA patients

• Post-op → analgesia, nerve blocks, pain busters

• Goals → knee flexion, indep. mobility, single leg reach

Day 0-1 Exercises/Mobility - quad exercises, flee flexion, mobilization, out of bed un-affected side, sitting allowed 30 mins, ice

Operative Type - Uni-compartmental knee replacement

Procedure similar to TKR, however only one compartment is replaced

• other compartment must be healthy

Operative Type - ACL Reconstruction + Indication

Indications: Significant functional disability due to instability

• Synthetic grafts (carbon fibre)

• Allografts (cadaver tendon donation)

• Autografts (hammys tendon)

Operative Type - Toe deformity surgery

Procedure: Osteotomy (cutting & replacing bones) of 1st Metatarsus Valgus

What are 4 examples of fracture complications?

1. Avascular necrosis

2. Joint instability

3. Delayed union of fracture site

4. Complex Regional Pain Syndrome (CRPS)

Physio role in trauma surgeries? (5)

1. Joint mobilisation

2. Exercises

3. Walking aids

4. Pain management

5. Swelling management

Surgical Management - Open Reduction External Fixation (OREF)

Stabilised using an external fixator

4 Causes of Hip Fractures

1. Simple fall - direct blow to the hip

2. Trip and fall - rotational force

3. Spontaneous - pathological

4. Traumatic fall - MVA, skiing etc

(Displaced) or (Undisplaced)

Clinical Features of a Hip Fracture (displaced vs undisplaced)

Displaced

• pain

• limb shortened / externally rotated

• unable to weight-bear

Un-displaced

• pain

• no change in limb orientation

• can sometimes weight-bear

• sometimes difficult to pick up on → Xray

Hip Surgical 4 Management Types

Garden I & II → Cannulated screws (un-displaced)

Garden III & IV → Hemiarthroplasty (displaced)

Intertrochanteric → dynamic//compression/Richards hip screw

Subtrochanteric → pin & plate

1’s or 2’s a pin or screw, 4’s or 3’s a hemi-arthroplasty

Signs and Symptoms of Post-op Delirium

• Decreased attention

• Disorganized thinking

• Irrelevant speech

• Disturbed sleep cycle

• Disorientation

• Memory impairment

Difference between Trauma vs Elective surgeries

Trauma surgery is urgent and performed in emergencies, while elective surgery is planned and scheduled in advance for non-urgent medical issues

Trauma Management: Prioritize life over limb, stabilize spine early, prevent complications

Elective Management: Optimize patient before surgery, minimize complications, early rehab, restore QOL

TSJR: Total Shoulder Joint Replacement Indications and Contraindications

Metal ball with stern + plastic socket in same anatomical shoulder layout

Indications:

• Affecting sleep or ADLs

• Glenoid cartilage degeneration

• Post. humeral head subluxation

Contraindications:

• Deltoid dysfunction

• Active infection

• RC arthropathy

• Brachial plexus palsy

RTSJR: Reverse Total Shoulder Joint Replacement Indications, Appropriate for and Post-op Physio

Humerus becomes the socket and ball in inserted into the glenoid

Indications:

• RC tear arthropathy (joint condition)

• Rheumatoid arthritis

• 3- and 4-part fractures

Appropriate for:

• More than 70 years old

• sufficient glenoid bone stock

• low functional demand

• intact axillary nerve

Post-op Physio:

• Chest circulation exercises + ice

• Mobilize out of bed early

• Sling until week 6

• No WB through shoulder

• PROM flex 90deg, max 120deg → no extension + ER

• TSR → needs rotator cuff

• RTSR → used when rotator cuff is NOT working

Rotator Cuff Repair

• Full vs partial thickness / traumatic vs spontaneous

• Candidates: Age, size of tear, limited activity, cooperative

Procedure →

• Arthroscopically or open, goal is to reattach good quality tendon to the bone. A grove is created in the normal attachment site and sutures draw the end of the tendon securely into the grove to heal

Post Operation: Day 1 up to 6 weeks

• Arm supported in a sling for 6 weeks

• Pendulum exercises, scapula stabilization, re-education and pain relief

Post Operation: 6-12 weeks

• Pain free arcs, pendulum, abduction active assisted 90deg, IR/ER

Post Operation: 12-16 weeks

• Strengthening RC muscles, plyometrics, neuromuscular control, sport-specific activity

Subacromial Decompression (SAD) Indications, Procedure and Post-Op

Indications:

• Conservative measures failed

Procedure →

• Procedure to increase the space available for structures that pass under the acromial arch

• Reshaping of acromion, ligament release, bursa removal etc

Post Operation:

• Arm supported in sling but removed ASAP

• Day 1: neck/scap/elbow/hand movements, education, icing, no abduction 3-6 weeks depending on Drs orders

Anterior Stabilization/Shoulder Reconstruction Indications, procedure and Post-op

Indications:

• Acute dislocation or recurrent instability

• Bankart lesion repair OR Hillsachs lesion repair

Procedure:

• Bankart → re-suture of the capsule and glenoid labrum through drill holes of the ant. glenoid rim (there will be a loss of ER)

• Hillsachs → Capsular shift, Bone grafting, Disimpaction, Remplissage, Shoulder replacement

Post Operation:

• avoid stressing the repaired structures until fibrous healing occurs at 6 weeks.

• Day 1 → Active elbow ROM in IR, passive shoulder flexion to 90deg and no ER

Clavicle Open Reduction Internal Fixation (ORIF) - Compression Plate Indications and Post-OP

Indications:

• shortening & displacement more than 2cm

• shoulder pathology + neurovascular repairs needed

Post Operation:

• Sling 1-2 weeks, NWB 6 weeks, PROM, resistance from 6wks

Humerus Open Reduction Internal Fixation (ORIF) Indications nd Post-op

Indications:

• Unacceptable deformity or risk of displacement

Post Operation:

• Weeks 0 - 3

  • Immobilization and/or support for 2-3 weeks, pendulum exercises, gently assisted motion, avoid external rotation for first 6 weeks

• Weeks 3 -9

  • Active-assisted forward flexion and abduction, gentle functional use week 3-6, gradually reduce assistance during motion from week 6

• Week 9 onwards

  • Add isotonic, concentric, and eccentric strengthening exercises, treat joint stiffness if any present

Distal Biceps Tendon Repair - Indications and Post-op

Indications:

• Biceps tendon avulsion

• Young active patients

• Needs to be repaired within 3 weeks of injury

Post -Op:

• Immobilisation in broad arm sling/full arm cast 6 weeks

• Slow return to full range of motion then strengthening at 6 weeks

Olecranon Open Reduction Internal Fixation (ORIF) - Bridge Plate Indications and Post-op

Indications: Unstable displaced #

Post Operation:

• Could be immobilized for a couple of days for pain, commence AROM as pain tolerates, resistance exercises commence at 4-6wks after confirmation of healing, nil loading elbow 6-8wks

Radial Head - ORIF or Arthroplasty Indications and Post-Op

Indications: Displaced or unstable # (ORIF) OR Irreparable # (Arthroplasty)

Post Operation:

• Could be immobilized for a couple of days for pain, commence AROM as pain tolerate, resistance exercises commence at 4 6wks after confirmation of healing, nil loading elbow 6-8wks

Radial and Ulna shaft Open Reduction Internal Fixation Indications and Post-op

Indications: Displaced closed #’s

Post Operation:

• Cast 6 weeks, commence AROM and strengthening post cast removal

Compartment Syndrome Indications and Post-op

Incidence: <30% forearm #s, higher incidence in crush injuries

Procedure: Fasciotomy, often left open for a few days until swelling subsides then repaired

Indications:

• Unrelenting, worsening pain more than expected for the injury, numbness and tingling in fingers, colour change of limb, pressure changes in limb

Post Operation: Casting to allow soft tissue to heal

Wrist, Hand & Finger Open Reduction Internal Fixation

WRIST:

Indications: Displaced or comminuted #’s

Post Operation: Cast 6 wks, commence AROM and strengthening post cast removal

HAND/FINGER:
Compression plate simple # + K-wire banding post avulsion #

Carpal Tunnel Release Indications and Post-op

Indications:

• Severe carpal tunnel syndrome with sensation loss and pain

Post Operation:

• Cast/splint 10-14 days, stitches removed 10-14 days post, gentle ROM commences, pain free movement commence wrist strengthening

Discectomy/Microdiscectomy Indications, Contraindications and Post-op

Removal of part or complete herniated disc impacting on spinal nerves

Indications:

• Spinal Cord compression, Cauda equina, spinal nerve root compression, radiological imaging, failure of non-operative treatments

Contraindications: NIL

Post Operation: Indep mobility, indep ADLs, limited lifting/flexion

Laminectomy Indications, Contraindications and Post-op

Removal of the lamina to enlarge the spinal canal to relieve pressure on the spinal cord or nerves

Indication: Spinal stenosis or radiculopathy

Contraindications: Instability

Post Operation: Indep mobility, indep ADLs, limited lifting, 70-80% positive outcomes

Complications: Spondylolistheses

Fusion (Operation) Indications, Contraindications and Post-op

Fuses 2 or more vertebral bodies together, to restrict spinal motion and remove the source of mechanical back pain to relieve symptoms

Indication:

• Trauma, tumor, segmental degeneration, spondylolisthesis, spondylolysis, deformity, DDD, recurrent disc herniation

Contraindications: Severe deconditioning/multimorbidity

Post Operation: Indep mobility, indep ADLs, limited lifting

Complications: Pseudoarthrosis (poor/incorrect bone fusion)

Corrective Surgeries + 5 types of procedures

Indication: Fixed deformity, stability of spine is compromised, neurologic deficit

Procedures:

• Osteotomy

• Decompression

• Fusion

• Rods – Magec Grow rod, Shilla Procedures

• Vertebral body stapling

What to do when you suspect a spinal injury?

1. Immobilize on rigid board (start spinal rules)

2. Apply rigid collar

Protection is priority, Detection is secondary

• Think about MOI, suspect in all unconscious patients, presence of red flags, beware the “distracting injury"

Algorithm to follow if a spinal injury is suspected

D Tbi Vbf Vpf

→ Displacement/dislocation

→ Tension band injury

→ Vertebral body fracture

→ Vertebral process fracture

Cervical Fracture causation, care + 3 types

Common in: 18–25-year-old males (80%)

Caused by: Head injury, high energy trauma, MVA

Care: Assume & immobilize until cleared, Needs neuro examination

Type A→ Bone injury only

Type B → Tension band/ligamentous injury

Type C → Translation Injury

What are the Canadian C-spine rules?

• Age ≥ 65 years

• Dangerous mechanism:

  • Fall > 1 m / 5 stairs

  • Axial load (e.g. diving)

  • High-speed MVC, rollover, ejection

  • Motorized recreational vehicle

  • Bicycle collision

• Paresthesia’s in extremities

What are the 5 Cervical managements?

• A0 - Minor, non-structural fractures (Soft collar)

• A1 - Compression # single end plate (Soft collar/spinal precautions, Halo, Surgery Anterior Plating)

• A2 - Coronal split/pincer fracture (Soft collar/spinal precautions, Halo, Surgery Anterior + Posterior Plating)

• A3 - Burst fracture of single endplate (Soft collar/spinal precautions, Halo, Surgery Anterior + Posterior Plating)

• A4 Burst fracture or sagittal split involving both endplates (Soft collar/spinal precautions, Halo, Surgery Anterior + Posterior Plating)

What are the 3 Thoracolumbar Type Classifications?

Type A → Compression Injuries

Type B → Distraction Injuries

Type C → Translation injuries

What are the 3 Subaxial Type Classifications? C Tb T

Tupe A → Compression Injuries

Type B → Tension Band Injury

Type C → Translation Injuries

Physio management - Braces and Surgery

Braces

• usually mobilised WBAT the day of brace application

• Lying → standing through side lying

• Educate: injury & expectations, warnings re-brace, doning and doffing brace, ADL’s, avoid heavy lifting/jumping/sustained flexion for 6 weeks

• MDT referrals

Surgery

• usually mobilized WBAT Day 1 post-op

• lying → standing through side lying and perching is recommended

• Educate: injury & expectations, ADL’s, avoid heavy lifting,/jumping/sustained flexion for 6 weeks

• MDT referral

What are 3 major causes of limb amputation? Pvd D T

1. Peripheral Vascular Disease

2. Diabetes

3. Trauma

What are the 3 amputation types?

1. Primary → performed as the initial treatment, usually when a limb is severely damaged or diseased (e.g. poor blood supply or infection) and cannot be saved

2. Secondary → after attempts to preserve the limb have failed (e.g. after surgery or treatment complications), so the limb is removed at a later stage.

3. Traumatic → Occurs at time of injury

Transtibial Amputation (TTA) technique

• Most common = Burgess technique

• Posterior flap is made from lateral and medial gastrocnemius and some soleus muscle

• Flap fixed anteriorly by sutures

• Also referred to as “Below Knee Amputation” (BKA)

Transfemoral Amputation (TFA) technique

• “Fish mouth” incision

• Myopexy of posteromedial musculature to shape stump

• Scar line sits at the base of the stump

• Also referred to as “Above Knee Amputation” (AKA)

Physio acute care Principles of an amputation/stump

Standard Post-op Care:

• Circulation exercises of other limb

• Sit out of bed early post-op

• Check bloods and vitals

Stump Management:

• Suture splitting

• Swelling, itching, inflammation

• Early prosthetic fitting

• Exercise rehab

Amputation: Stump pain & Phantom pain

Stump Pain → wound healing, requires good pain control

Phantom Pain → 20-50% patients describe it as crushing, toes twisting, burning, tingling, cramping

What are 4 causes of ongoing stump pain?

1. Abscess, infection, skin conditions etc

2. Muscle contractures

3. Neuromas (nerves cut in operation)

4. Bony spurs at the cut end of bone

2 Advantages & 2 Disadvantages of Removable Rigid Dressings (RRD) in stump care

Advantages → Reduced oedema and shapes the stump

Disadvantages → Can be heavy & specialist required for application

• Needs to be applied in theatre and to be worn for up to 2 weeks (progress to shrinker socks)

2 Advantages & 2 Disadvantages of Bandaging/shrinker socks in stump care

Advantages → Washable and easy to don/doff

Disadvantages → May slip off and slower healing

• Bandaging → 2-4 days post-op once wound dressings are minimized and pain allows

• Shrinker socks → 7-10 days when conical shape is forming

Bandaging guidelines for Stumps/amputations

• Check stump first, dressing over wound

• All bandage turns should be diagonal (not spiral) to avoid tourniquet (figure 8 dressing)

• Never restrict blood flow = reduced circulation

• Should be applied with extended knee

• Graduated pressure, firm at end of stump, apply pressure on upwards turns.

• Re-apply every 4 hr

• No folds, creases, windows

• No pins to secure, use only tape

• Worn 24/7