Managing the Patient Undergoing Orthopedic Surgery

Managing the Patient Undergoing Orthopedic Surgery

Many patients with musculoskeletal dysfunction undergo surgery to correct the problem. Problems that may be corrected by surgery include unstabilized fracture, deformity, joint disease, necrotic or infected tissue, and tumors. Frequent surgical procedures include open reduction with internal fixation (ORIF) and closed re-duction with internal fixation (fracture fragments are not surgi-cally exposed) for fractures; arthroplasty, meniscectomy, and joint replacement for joint problems; amputation for severe extremity problems (eg, gangrene, massive trauma); bone graft for joint sta-bilization, defect-filling, or stimulation of bone healing; and ten-don transfer for improving motion. The goals include improving function by restoring motion and stability and relieving pain and disability. See Chart 67-7 for descriptions of orthopedic surgeries.

Joint surgery is one the most frequently performed orthopedic surgeries. Joint disease or deformity may necessitate surgical inter-vention to relieve pain, improve stability, and improve function. Surgical procedures include excision of damaged and diseased tis-sue, repair of damaged structures (eg, ruptured tendon), removal of loose bodies (débridement), arthroplasty (replacement of all or part of the joint surfaces), and arthrodesis (immobilizing fusion of a joint).

The procedure is based on the patient’s underlying orthope-dic condition, general physical health, impact of joint disability on daily activities, and age. Timing of these procedures is impor-tant to ensure maximum function. Surgery should be performed before surrounding muscles become contracted and atrophied and serious structural abnormalities occur. The physician care-fully evaluates the patient so that the most appropriate procedure is performed.

Because these are elective procedures, many patients donate their own blood during the weeks preceding their surgery. This blood is used to replace blood lost during surgery. Autologous blood trans-fusions eliminate many of the risks of transfusion therapy.

Also, during surgery blood is conserved to minimize loss. A pneumatic tourniquet may be applied after exsanguination of the limb with bandages to produce a “bloodless field.” Intraoperative blood salvage with reinfusion is used when a large volume of blood loss is anticipated. Postoperative blood salvage with intermittent autotransfusion also reduces the need for blood transfusion.