Year

4 Orthopaedic Rotation

Overview

Orthopaedics is the management of diseases of the musculoskeletal system. The word Orthopaedia is
derived from two Greek words Ortho- meaning straight and pedia- child. Orthopaedia was the title
of the self-help book written by Nicholas Andre a Parsian pediatriacian.

The year 4 Orthopaedic rotation consists of five weeks at one of 3 sites:

a) University Hospital of the West Indies (UHWI)

b) Kingston Public Hospital (KPH)

c) Mandeville Regional Hospital (CRH)

Students are required to select the site of their choice prior to starting the rotation. This is to ensure a
particular site is not over subscribed and to ensure all sites are used. Given the size of each group of
students site selection is essential and if not done by the student then will be automatically assigned by
the faculty.

Each site has minor variations in the rotation, activities and teaching methods but all site aim to provide
the student with the same basic information. Students start at UHWI the first week, leave for the other
sites on week 2 and return to UHWI for the final week. Transportation and accommodation is arranged
by the deans office.

Dr Wayne Palmer is the coordinator for the rotation and be contacted at

wayne.palmer02@uwimona.edu.jm , 927-1211 or ext 2146.

Lecturers-

UHWI- Drs Kenneth Vaughan, Akshai Mansingh, Christopher Rose, Dr Andrew Ameerally and Wayne
Palmer

KPH- Drs Ian Neil, Melton Douglas and Conrod Lawson

MRH- Drs Steve Mullings and Gwyn Jones

Clerkship evaluation-

Typically takes place the last Friday of each rotation at 9 am in the Computer lab at the Medical sciences
building.

1) MCQ- 30 questions- simple and Extended matched Questions (EMQ) - 60%

2) Clinical Online Exam- 10 short Quiz set as 10 stations. One theme per station short answers-
30%
3) Procedure card- 10%


Aims

The primary aim of the clerkship is to introduce the students to examination of the musculoskeletal
system and the principles of management of common orthopaedic problems.

Learning Objectives

At the end of the clerkship the student should be able to do the following:

1. Take a history and perform an appropriate examination for a patient with a musculoskeletal
injury
2. Demonstrate the ability to formulate a diagnosis, differential diagnosis and outline the most
suitable treatment for patients with musculoskeletal injuries.
3. Discuss the investigations used in evaluating patients with fractures and other orthopaedic
injuries, including the awareness of indications for plain x-rays, CT scan, MRI and bone scans.
4. Describe the anatomy of bones and joints as it relates to abnormal findings on plain radiographs
including changes seen with fractures and dislocations.
5. Describe the indications for non-operative and operative management.
6. Discuss the various methods of fixation, including the use of internal and external fixation
devices.
7. Describe the common complications of fractures.
8. Describe practical tips to the prevention of fractures.
9. Perform the reduction of simple dislocation and be able to manipulate a fracture into anatomic
alignment and apply a plaster of Paris back slab.
10. Discuss the principles uses and complications of skin and skeletal traction.
11. Describe the methods of insertion of pins for skeletal traction.
12. Describe the clinical, radiological and treatment options for the following conditions:
Fractures and dislocations
Traumatic soft tissue injuries
Ligament, tendon and nerve injuries
Bursitis and tendonitis
Joint instability
Benign and malignant bone disease
Metabolic bone disease
Bone and joint infections (osteomyelitis and septic arthritis)
Nerve entrapment syndromes
Arthritis (degenerative, inflammatory)
13. Perform aspiration of superficial joint e.g. Knee, ankle, elbow etc.


Core Topics
1. Fractures- definition, mechanism, investigations ,treatment options, complication, prevention,
healing
2. Joint pains- differential ,clinical features, investigations etc
3. Tumours- Benign ,malignant principles, biopsy etc
4. Infections- types investigations treatment etc
5. Deformities- congenital acquired and idiopathic
6. Back and neck pain- diagnosis and treatment
7. Ligament Injuries- ankle and knee
8. Dislocations- Hip, shoulder and knee

Student activity card

Perform /assist

1. Collies fracture reduction

2. Collies plaster
3. Reduction shoulder dislocation
4. Reduction other dislocation (hip, digit, elbow etc)
5. Insertion stienman pin
6. Set up skin traction
7. Application Ak pop
8. Application Bk pop
9. Application cylinder

Observe

1. Application club foot plaster

2. Release trigger finger
3. Release De Quervains tenosynovitis
4. Excision Ganglion
5. Decompression Carpal tunnel

Attendance

Seminars

Tuesdays date/sig

Teaching Ward rounds

Date/sig

Operating theatre

Date/ sig

Clinic

Date/sig

Other teaching sessions (consultant)

Date/sig

Night duty

Date/sig

Time table of activities at UHWI

Monday

7:30am *Firm ward rounds All groups

9:00-12 noon Orthopaedic clinic groups A&B Drs Mansingh/Palmer

9:00-12 noon Main Operating Theatre- group C Dr Rose

Tuesday

9:30-12 noon Teaching Rounds and case presentations-groups A,B&C Dr Palmer

2:00-3:00pm Clinical Examination Seminar - groups A,B&C Resident

Wednesday

7:30am *Firm ward rounds All groups

8:00-12 noon Main Operating Theatre-group B Dr Vaughan

9:30-10:30 Firm Teaching- group B&C Resident/Consultant

**9:00-12noon Bustamante Hospital for children (final year students) Dr Sawh

Thursday

7:30am *Firm ward rounds All Groups

8:00-12noon Main Operating Theatre-group A Drs Mansingh/Palmer

9:00-12 noon Orthopaedic Clinic- groups B&C Dr Vaughan

Friday

7:30am *Firm ward rounds All Groups

9:30-10:30 Firm teaching -group B Resident /Consultant

**8:00-9:00 Seminar with final year students Dr Rose

9:00-12 noon Orthopaedic clinic-groups A&C Dr Rose/Dr Ameerally

1:00-2:30 pm Minor Operating Theatre- 1st and 3rd week group 1

2nd and 4th week- group 2

*these rounds are conducted by the specific firm and are not necessarily teaching rounds