Orthopaedic surgery - Managing your expectations following Fracture Clinic

Trauma Coordinators - 0161 206 1454
Admin Team - 0161 206 2017
Plastics Nurses - 0161 206 5898

Introduction

This leaflet provides an insight into what to expect following your fracture clinic appointment, and how we can manage your expectations. Since the development of our new trauma centre, the trauma and orthopaedic services have been busier than ever. Despite this, we work as part of a multidisciplinary team to ensure that patients who have been referred for surgery have their operation in a timely manner.

First stages of care

Every morning, we have a trauma meeting where orthopaedic consultants, junior doctors, registrars, and nurses will attend to discuss patients that have been seen either during the day or overnight. During your hospital visit, you will have been reviewed by our orthopaedic on call doctors. This trauma meeting is where decisions are made regarding patients’ care.

If it has been decided that you will need to be seen by one of the orthopaedic consultants, then our admin team will be in touch with you with an appointment date and time. This will be in our fracture clinic and will be with a consultant that specialises in your type of injury.

This should be a 15-minute consultation and discussions will be made regarding your injury and whether the consultant believes that an operation is needed or not.

What happens if you are listed for surgery?

Once this appointment has finished, the consultant may send you for a pre-operative assessment. This will be done by one the nurses in fracture clinic, and will involve questions regarding your medications, allergies, and medical history. You may also have blood samples and MRSA swabs taken. If you have quite an extensive medical history, you may be sent down for a ‘one stop pre-op’ or to the main pre-operative department, they will obtain further information and conduct further examinations.

Once everything has been completed, the consultant who saw you during your appointment will contact the trauma coordinators with your information. Once this has been communicated, we will aim to find an appropriate date for your surgery.

What do the trauma coordinators do?

As trauma coordinators, part of our job is to list patients for surgery. We use online systems to keep track of all the trauma patients that are awaiting surgery. We look through these online systems daily with the operating consultants to make decisions based on clinical priority of patients and what consultant specialities we have available for your surgery.

Since the Trust now has major trauma status, the trauma service can be extremely busy, and there can be a lot of patients admitted through the day and night that need their surgery as a matter of urgency. This means that if you are currently waiting at home for surgery, it can sometimes take some time to find an appropriate date for you to come into hospital for your operation. However, we would like to re-assure you that we have not forgotten about your surgery.

How to prepare for your surgery

When a date for your surgery has been agreed, the trauma coordinators will phone you with important information. Due to the unpredictability of trauma, this will usually be the day before your surgery. The information includes:

• Fasting instructions - you will not be able to have any food after 2am and can have sips of water only throughout the morning so long as it is less than 150ml/hr
• Instructions on where to attend - we will ask you to attend the day case unit on the 1st floor of the Turnberg Building at 7am. This is to ensure you are fully admitted by the day case staff before the trauma list starts
• Bed status - if you have been listed as a day-case procedure, you should be able to go home following your operation. This will be on the basis that you have somebody to stay with you at home for 24 hours post-op for safety purposes. However, if it has been decided that you will need a hospital bed, you will be asked to bring an overnight bag in preparation for your hospital stay
• Anticoagulants and other medications - your medications should be discussed during your pre-operative assessment. If you are taking any blood thinners or other medications that may need to be stopped prior to surgery, please let the nurses in fracture clinic know so that they can be stopped accordingly
• Transport - if you have any queries regarding your transport into hospital/require an ambulance transport, please contact the trauma coordinators on the telephone number above and we can give you some help with this
• Lower limb fractures ONLY: Follow advice regarding keeping your limb elevated and iced to reduce swelling/prevent cancellation on the day

Cancellations

As we are a major trauma centre, we can receive an influx of trauma patients needing surgery overnight. Therefore, in certain circumstances your surgery may unfortunately be cancelled on the day. There are other reasons for cancellation, including:

• Lack of theatre time and/or capacity
• An emergency patient admission during the day that needs theatre within a specific time frame
• If a bed isn’t available for you after your surgery
• Not following fasting instructions