UNDERGOING AN ORTHOPAEDIC SURGICAL PROCEDURE
The range of treatments performed by an orthopaedic surgeon may cover anything from traction to hand reconstruction, spinal fusion or joint replacement. They are involved in the treatment of broken bones, ligamental strains and sprains, as well as joint dislocations. Some specific procedures include arthroplasty, arthroscopic surgery, bone grafting, fasciotomy, and fracture fixation.
In general orthopaedic surgeons are attached to a hospital, medical center, trauma center, or free-standing surgical center where they work closely with a surgical team including an anesthesiologist and surgical nurse. Orthopedic surgery can be performed under general, regional, or local anesthesia.
YOUR PRE-OP EXAM
The doctor may ask about your medical history, do a physical exam, and order some tests to ensure your fitness for surgery.
• Blood tests provide information about your blood and body chemistry.
• An ECG (electrocardiogram) records your heart function.
• A urinalysis (analysis of urine) gives information about your kidneys and bladder function.
• A chest x-ray shows an image of your lungs.
• Other tests may also be done to make sure you are fit for surgery.
Bring any previous tests results on these or others that you may have at home before the surgery.
THINGS TO DO BEFORE THE SURGERY
1. Inform your doctor on your medication intake, including aspirin, anti-inflammatory medications, herbs, or vitamins.
2. Make arrangements to have someone to drive you to and from the surgery, or consider taking a taxi. Don’t drive yourself.
3. Make arrangements for someone to take care of you for at least the first 24-72 hours after the surgery
4. Fill prescriptions (especially pain medication and antibiotics) before the surgery
5. You need to fast for 6 hours prior to surgery, but may consume small amounts of plain water
6. Come to the clinic 2 hours before to collect the admission letter and preparation information.
7. Prepare for surgery fee deposit/ payment and hospital payment (cash in sgd$, visa, master, amex, or nets.)
8. Please do not bring too many valuables to the hospital.
9. Ask for a locker at the hospital
10. For day surgery procedures a two bedded ward is usually booked by our staff. Please inform us early on for changes of room type.
11. Set up a home recovery area (lots of pillows, books, magazines, journals, videos, favourite cds, etc.)
12. Stock up on quick snacks: protein shakes, soup, oatmeal, cheese, juice etc.
13. Be sure to eat adequate amounts of protein such as meat, fish, eggs, diary products, soya (the body needs it for proper healing)
ARRIVING FOR SURGERY
• Bring your insurance card and any forms you need the doctor to fill in upon admission at the hospital, you will get an ID bracelet, and be taken to a ward to get ready.
• Your family and friends may be asked to stay in a waiting area.
Before the surgery, a doctor or nurse will talk you through the anaesthesia procedure (medication which blocks pain and keeps you comfortable during the surgery).
IN THE OPERATING THEATER
The operating theater (OT) is staffed by a team of trained professionals. The OT provides the most sterile and safe surgical setting possible.
YOUR SURGICAL TEAM
• The Surgeon, who is responsible for your overall care, leads your surgical team.
• A surgical assistant helps on many major surgeries.
• An anaesthesiologist and nurse anaesthetic assistant provides the anaesthesia and other medications to keep you comfortable during surgery, and monitor your vital signs.
• A surgical technologist sets up instruments and assists the surgeon.
• A circulating nurse prepares the OT, makes sure sterile methods are followed, and helps other team members
After surgery, you will be brought to the recovery room to receive constant care from a post anaesthesia care nurse. When you are coming out of surgery, your doctor will speak to your relatives to update them on your condition.
As the anaesthetic wears off, you will “wake up” in the recovery room.
• Noises may sound louder than normal.
• You may have slight blurry vision, a dry mouth, chills, or nausea.
• A nurse will check on your dressing and blood pressure often.
• Your surgery site may feel uncomfortable; ask your nurse for medication if you need it.
• You may be asked to do some deep breathing and coughing to help clear your lungs.
• Your nurse may ask you to move around a little in bed, because small movements will help you recover faster.
Your doctor and nurses will check on you after surgery. If you feel pain or nausea, let them know.
Walking helps your blood flow better. It also helps your body functions get back to normal. Be sure to ask for help the first time you get up out of bed, and begin walking.
BREATHING AND COUGHING
In the hospital, you may be asked to use a spirometer (deep breathing exerciser). Deep breathing clears the lungs and helps prevent pneumonia. You may also be asked to cough. This may be difficult at first.
Food may be hard to digest after surgery. You may have an IV for fluids and nutrition when you are in the hospital. A dietitian will help decide what foods are best for your when the doctor says you may begin eating. You will start with liquids. Later, you will eat solid foods. At home, follow your doctor’s orders about eating and drinking.
You are likely to spend most of your time recovering from surgery at home. Make sure to plan your home care. Also, you will need to visit your doctor’s clinic sometime after you leave the hospital. Be sure to keep these appointments, and if you have any questions you should bring these up to the doctor.
LEAVING THE HOSPITAL
A hospital staff member will take you to your ride or taxi. You won’t be allowed to drive yourself home. At home, ask your relative’s to accompany you until the wound is more or less healed. If you have any questions feel free to contact our clinic.
WHAT TO DO AFTER DISCHARGE FROM THE HOSPITAL?
You will only be discharged from the hospital once you are stable. You will then be given an appointment which is usually 3 days later and orthopaedic accessories/medications if necessary. These include:
• Anti-inflammatory medications
• Orthopaedic accessories
The purpose of antibiotics is to reduce the chances of getting wound infections. It is important that you complete the whole course.
Examples: Avelox, Rocephine, Ciprolet
The role of the inflammation medication is to reduce the post-surgical inflammation and pain. It is recommended that the patient completes at least half off the prescribed quantity and adopt the “wait and see” approach. If the pain subsides substantially, then you may stop the medication without completing the whole course.
Example: Celebrex, Arcoxia etc
The accessories are often used as external applications to aid wound healing, and to protect the wound during its recovery phase.
• Place Cold Pack flat in freezer for at least 30 minutes.
• Remove Cold Pack from freezer and place in a towel before applying. Never apply cold therapy longer than 30 minutes at a time.
During treatment, inspect the skin every 5 minutes where compress is applied. If any discoloration or redness occurs discontinue treatment at once.
• Immerse Hot Pack in warm water for 5-7 mins
• Check the temperature of the Hot Pack. If it is too hot then let it cool down.
Always apply with a wrapping towel.
Bandage / Cast Cover
• Reusable Cover to prevent bandage / cast from getting wet during shower
• Available for Arm and Knee
The Cryocuff system contains 3 basic components:
• Cuff- covers the injured area.
• Cooler- holds enough water and ice for 6 to 8 hours of cryotherapy.
• Tube- exchanges the water between the cooler and cuff.
All knee and shoulder Cryocuffs use the same cooler and fittings.
An insulated Cryocuff holds up to 4 liters of ice and water – enough for 8 hours of therapy.
• Elevating the cooler fills and pressurizes the cuff.
• Compression is controlled by gravity, and is proportional to the elevation of the cooler. For example, if the cooler is 20″ above the cuff during filling, the applied compression will be approximately 35mm Hg (1″ elevation = 1.8 mm Hg pressure).
• When body heat warms the water, it is re-chilled simply by lowering the cooler.