Other injuries and pre-operative decision making

X-rays and further examination also revealed a severely damaged left hock. One side of the joint had been abraded by the road surface, destroying the ligaments that stabilise the joint on one side and exposing the delicate joint surfaces to infection.

Although this patient had sustained severe orthopaedic injuries these were not life threatening. By contrast a pneumothorax is potentially unstable and compromises the patient's ability to breath. The initial priority therefore was to treat and stabilise the patient's chest until he was well enough to cope with anaesthesia and surgery for his other injuries. In some cases a tube is placed into the chest to remove the abnormally located air; this was unnecessary this time as the patient improved over a 3 day period with initial oxygen therapy, intensive nursing, antibiotics, pain relief and intra-venous fluids. Nursing was a challenge in this case as the patient was critically ill and unable to walk.

After 3 days the patient was well enough for us to start to tackle his other injuries. Although dislocated hips will sometimes stay in place if replaced this patient's continually re-dislocated - a surgical solution was therefore required. In some cases the ball of the femur cannot be replaced in the socket on the pelvis without an operation and a full surgical procedure is then needed. Here the ball would go into the socket but not stay put - a less invasive option was to place an external frame to keep the joint together while it heals. This can be done without a large surgical incision and dissection and is therefore less traumatic for the patient.