Orthopaedic Resources

Plastering help

Click here for an excellent guide to plastering including written guides and video tutes developed right here in Bendigo by phsyiotherapist and Master student Jessica Dix and skilfully demonstrated by plaster technician Jason Colson.

Paediatric Fractures

Click here to go straight to the guidelines

The new Childhood Fracture Management Project provides all Victorian hospitals with best-practice guidelines and education for treating and managing paediatric fractures.

In October 2012 these guidelines became a subset of the RCH Clinical Guideline but deserve special mention due to their usefulness and relevance to very common emergency department presentations.

Led by the Victorian Paediatric Orthopaedic Network, in collaboration with The Royal Children’s Hospital, the Childhood Fracture Management Project is an online resource for the identification and management of 22 of the most common upper and lower limb paediatric fractures.

 

The Childhood Fracture Management Project includes two key components:

  1. Clinical practice guidelines, including
    • Casting videos
    • X-ray examples
    • Fact sheets
  2. Education Module, including
    • Animations
    • X-ray examples
    • Quiz

Scaphoid fracture and suspected scaphoid fracture pathway

Click here for the pdf of Physio, Theo Kapakoulakis' pathway for management of scaphoid fracture.

There are a few important things to consider when managing a suspected (i.e. clinical suspicion but no X-ray evidence) scaphoid fracture.

  1. Scaphoid fractures can be X-ray negative
  2. Scaphoid fractures can lead to avascular necrosis and chronic wrist immobility and pain
  3. X-ray negative scaphoid fractures might be amongst those that have a bad outcome
  4. Immobilising these in plaster of some sort might make a difference to the rates of those bad outcomes
  5. Wearing plaster for 10 days is a real pain in the neck, especially if you work with you hands, have both of them in plaster or have others to care for.

For these reasons please:

  • Make a proper clinical assessment of the chance of an occult scaphoid fracture (see the pathway)
  • Always use a removable thumb spica slab rather than a full cast for the X-ray negative possible scaphoid fracture
  • Consider whether early diagnosis today or tomorrow with CT or MRI is worth the money and resource use. If there is a clear benefit to the community in early diagnosis (e.g.police officer who will be off work on sick leave for a week in POP or back at work in 2 days with a negative MRI; elderly person who can't self care in POP and will need to come in to a rehab bed but who could go home from SSOU with a negative CT/MR) then advanced imaging here may be warranted.
  • Consider whether early diagnosis might be so valuable to the patient that they are willing to pay for it privately (e.g. self-employed builder)
  • If you are opting for traditional management with immobilisation and fracture clinic ensure that follow up Xrays are taken out of plaster

 

Other online orthopaedic resources

Wheeless Text book of orthopedics from Duke university.

Australian Orthopaedic Society Reference