Surgery and Orthopedics in Primary Care
Primary-care surgery and orthopaedics tests recognition, initial stabilisation and appropriate referral for acute abdominal pain, wounds, hernias, fractures, soft-tissue injury and back pain. You are not expected to perform major operations, but you must not miss limb- or life-threatening conditions.
Core rules
- Assess the acute abdomen with vital signs, hydration, sequential examination and targeted tests; analgesia should not be withheld.
- Open fractures need antibiotics, tetanus cover, wound cover and urgent orthopaedic referral.
- Before and after splinting, document distal pulses, sensation, capillary refill and motor function.
- Back pain with red flags-fever, urinary retention, saddle anaesthesia, progressive weakness, cancer history or trauma-needs urgent evaluation.
- Wounds need cleaning, debridement of devitalised tissue, closure timing and rabies or tetanus assessment.
Worked example
A 9-year-old falls onto an outstretched hand. The wrist is swollen and tender distally, with normal pulses and sensation. The reasoning: suspect a distal radius fracture. Provide analgesia, immobilise in a splint, check neurovascular status again, arrange X-rays, and refer if displaced or if growth-plate injury is suspected. Do not manipulate a child’s fracture in a clinic without appropriate expertise and imaging.
Traps
Missing compartment syndrome because pain seems “expected”; prescribing opioids without reassessment; suturing a contaminated bite wound tightly; treating cauda equina as mechanical back pain; and failing to document neurovascular status.