OR13.1-2 | Orthopaedic Procedural Skills — Glossary

Advanced Trauma Life Support — the standardised framework for systematic assessment and resuscitation of trauma victims, developed by the American College of Surgeons, using the ABCDE sequence to prioritise life-threatening conditions in order of their time-to-death urgency.

A non-circumferential posterior plaster slab applied in the acute setting when significant swelling is anticipated; it allows for swelling without the restriction of a full circumferential cast, reducing the risk of compartment syndrome.

Dividing a circular cast longitudinally into two halves (front and back) to relieve external pressure on a swollen limb; performed when cast splitting alone is insufficient to relieve compartment pressure.

A triangular bandage supporting the forearm at 90° of elbow flexion across the chest, used for clavicle fractures, acromioclavicular joint injuries, and shoulder fractures to reduce pain and prevent further displacement.

A sling supporting only the wrist from the neck, allowing the weight of the arm to produce gentle traction at the fracture site; specifically indicated for surgical neck of humerus fractures.

A branch of the sciatic nerve that winds around the neck of the fibula and is vulnerable to compression in below-knee casts; injury causes foot drop (weakness of dorsiflexion and eversion).

A limb-threatening condition in which elevated pressure within an osteofascial compartment compromises perfusion of the enclosed muscles and nerves; early signs include pain out of proportion and pain on passive muscle stretch.

Application of posterior pressure on the cricoid cartilage to compress the oesophagus between the cartilage and the C5/C6 vertebra during RSI, intended to prevent passive regurgitation of gastric contents into the pharynx; maintained until the endotracheal tube cuff is inflated and correct placement is confirmed.

A trauma resuscitation strategy that limits crystalloid infusion and uses blood products (PRBC:FFP:platelets in 1:1:1 ratio) to restore haemostasis and perfusion simultaneously, preventing the lethal triad of acidosis, hypothermia, and coagulopathy.

The difference between diastolic blood pressure and measured compartment pressure; a ΔP of less than 30 mmHg (or an absolute compartment pressure >30 mmHg) is the threshold for performing emergency fasciotomy.

A systematic assessment of motor function, sensation, skin colour, capillary refill, temperature, and pulse distal to a fracture or cast; must be performed and documented before and after every cast application.

A systematic check for post-intubation deterioration: Displaced tube, Obstructed tube, Pneumothorax, Equipment failure; used when ETCO₂ is lost or oxygenation deteriorates after confirmed intubation.

The concentration of carbon dioxide measured at the end of each exhalation; a continuous capnography waveform is the gold-standard confirmation of correct endotracheal tube placement in the trachea and is lost immediately with oesophageal intubation.

Placement of a cuffed endotracheal tube through the vocal cords into the trachea to secure the airway against aspiration and enable controlled positive-pressure ventilation; confirmed by bilateral breath sounds and continuous end-tidal CO₂ waveform.

A fixed plantar-flexion deformity of the ankle resulting from immobilisation in plantar flexion or unopposed Achilles tendon contracture; prevented by casting the ankle at 90° neutral.

Surgical incision of the fascia enclosing a muscle compartment to release elevated compartment pressure and restore perfusion; the definitive treatment for established compartment syndrome.

A bandaging technique applied around both shoulders in a figure-of-eight configuration to retract the shoulders posteriorly and reduce clavicle fractures by maintaining fracture fragment approximation.

An indwelling urinary catheter with a self-retaining balloon at its tip, inflated with sterile water after confirmed bladder entry; used for continuous bladder drainage and urine output monitoring during resuscitation.

A fluid dynamics equation stating that flow rate through a cylinder is proportional to the fourth power of the radius and inversely proportional to the length; in clinical terms, a short wide-bore IV cannula delivers fluid significantly faster than a long narrow central venous catheter.

Emergency vascular access obtained by inserting a needle into the medullary cavity of a bone (typically proximal tibia) to reach the non-collapsible venous sinusoids; used when peripheral IV access fails in a critically ill patient.

The bony prominence on the inferior surface of the ischium on which the padded ring of the Thomas splint rests, providing the counter-traction point for femoral shaft fracture management.

The principle that a cast for a long-bone fracture must span both the joint proximal and the joint distal to the fracture site to prevent rotational and translational forces from acting at the fracture.

A dissociative anaesthetic agent (1–2 mg/kg IV) that produces analgesia, sedation, and anaesthesia while maintaining airway reflexes and sympathetic tone; the preferred induction agent for RSI in haemodynamically unstable trauma patients because it supports blood pressure rather than reducing it.

A metabolic marker of tissue hypoperfusion produced when cells switch to anaerobic glycolysis; a serum lactate >4 mmol/L indicates severe shock and predicts the need for massive transfusion; clearance toward normal (≤2 mmol/L) within 2–4 hours of resuscitation correlates with improved survival.

A superficial forearm vein that crosses the antecubital fossa diagonally between the cephalic and basilic systems; the most commonly cannulated vein for IV access in trauma due to its large calibre, superficial course, and relative fixity.

Soft cotton-based padding applied between the skin and the plaster bandage to protect bony prominences and neurovascular structures from pressure necrosis during immobilisation.

A damage control resuscitation strategy that accepts a reduced target blood pressure (typically systolic 80–90 mmHg) in penetrating trauma patients until surgical haemostasis is achieved, to avoid dislodging nascent clots and diluting coagulation factors.

Calcium sulphate hemihydrate (CaSO₄ · ½H₂O), which when mixed with water undergoes an exothermic hydration reaction to form calcium sulphate dihydrate, producing a rigid, immobilising cast used in fracture management.

The optimal resting joint position that minimises deformity if stiffness develops during immobilisation; for the wrist it is 20–30° dorsiflexion, for the ankle 90° neutral, for the elbow 90° of flexion.

The initial rapid assessment of a trauma patient following the ABCDE framework (Airway, Breathing, Circulation, Disability, Exposure), identifying and treating immediate life threats before proceeding to a systematic secondary survey.

An intubation technique for securing a definitive airway in patients presumed to have a full stomach, using simultaneous induction and neuromuscular blockade to minimise aspiration risk while achieving rapid onset of paralysis.

A method for placing catheters into blood vessels using a needle-guidewire-dilator-catheter sequence, named after Sven-Ivar Seldinger; the standard approach for central venous catheter and arterial line placement.

A method of applying traction to a limb through adhesive or non-adhesive skin tapes, used in conjunction with the Thomas splint for temporary femoral shaft fracture management.

A catheter inserted percutaneously through the lower abdominal wall into the distended bladder above the pubic symphysis, used as the safe alternative to urethral catheterisation when urethral injury is suspected.

A depolarising neuromuscular blocking agent (1–1.5 mg/kg IV) used in RSI for its rapid onset (60 seconds) and short duration (8–10 minutes); contraindicated in burn/crush injuries >48 hours old, hyperkalaemia, and malignant hyperthermia risk.

A traction splint consisting of a padded ischial ring and two lateral bars, used as a temporising device for femoral shaft fractures to provide longitudinal traction, reduce haemorrhage, and align fracture fragments prior to surgical fixation.

A technique used when setting a below-elbow cast for distal radius fractures, in which three counteracting forces are applied at the fracture site, the wrist, and the forearm to maintain fracture reduction within the cast.

Disruption of the urethra, most commonly at the bulbar or membranous segments following pelvic fracture or straddle injury; clinically suspected when blood is seen at the urethral meatus, making transurethral catheterisation absolutely contraindicated.

The volume of urine produced per unit time (measured hourly via a Foley catheter in resuscitation); a target of ≥0.5 mL/kg/hour in adults serves as a real-time indicator of adequate renal perfusion and resuscitation adequacy.

A late complication of missed or undertreated compartment syndrome of the forearm, resulting in fibrosis and shortening of the flexor muscles, producing a fixed flexion deformity of the wrist and fingers.