Orthopedic Surgery and Sports Medicine

01Purpose and scope

• This manual supports the course Orthopedic Surgery and Sports Medicine. It describes how clinicians, surgical teams, athletic trainers, physical therapists, and support staff organize the care of patients with injuries and conditions of bones, joints, muscles, tendons, and ligaments.
• The scope covers acute trauma, degenerative joint disease, sports-related injury, elective procedures, and the recovery period that follows. It is written as a reference for how the work is actually done in clinics, operating rooms, and sideline or training settings. It is not a substitute for formal training or for supervised hands-on experience.
• Practice varies a great deal. A level one trauma center, a hospital based elective joint service, a university sports medicine clinic, and a community orthopedic practice each set different priorities, staffing levels, and patient throughput. Where this manual describes a step, assume that local protocol, credentialing rules, and the surgeon's judgment take precedence.
• Guidance here does not replace qualified professional judgment, approved institutional procedures, or required authorization. Scope of practice, consent requirements, reporting duties, and controlled substance rules depend on jurisdiction and facility. Check the current requirements of your state medical board, your hospital policy, and the relevant professional bodies before acting on anything in this manual.

02Core principles

• Start from function, not only from imaging. A radiograph or magnetic resonance image shows structure, but the patient's ability to load, move, and work tells you what matters. Many findings that look dramatic on imaging are incidental in people with no symptoms, which is why the history and examination carry so much weight.
• Match the intervention to the problem and to the patient. Conservative care, injection, arthroscopy, open reconstruction, and joint replacement each carry different risk, recovery time, and reliability. A common error is moving to surgery because it feels decisive rather than because the indication is clear.
• Treat recovery as part of the treatment. Surgical outcome depends heavily on rehabilitation timing, adherence, and the patient's own goals. The plan should name the expected trajectory, the milestones, and the criteria for return to activity before the patient leaves the first visit.
• Shared decision making is the default. Patients need to understand expected benefit, realistic recovery time, and what happens if they decline treatment. For athletes, the decision may also involve coaches, parents for minors, and sometimes employers, so the clinician must be clear about who holds decision authority and who receives information.

03Planning and preparation

• Start with a clear clinical question. What is the working diagnosis, what must be ruled out, and what decision is pending? Write the answer in one sentence. This keeps the workup proportionate and stops orders from piling up without a purpose.
• Gather the record before the visit. Prior operative notes, imaging on disc rather than only the written report, medication lists, allergy history, and earlier rehabilitation records all change the plan. For athletes, request the season calendar, position demands, and any concussion or cardiac screening history that is on file.
• Confirm resources before committing to a timeline. Check operating room availability, implant inventory, imaging scheduling, and physical therapy capacity. A surgery date that cannot be followed by post-operative therapy slots creates avoidable delay and often leads to stiffness or weakness that could have been prevented.
• Prepare the consent conversation in advance. List the procedure, the alternatives including no treatment, the common risks such as infection, stiffness, bleeding, nerve injury, and the possibility of further surgery, and the expected recovery in plain language. Add patient-specific risks when they change the picture, such as tobacco use, poorly controlled diabetes, or a body mass index that affects implant choice or wound healing.

04Recommended workflow

1. 1
   : Intake and triage. Record the mechanism of injury, the onset, prior treatment, current function, and the patient's goals. Classify urgency at the outset: open fractures, vascular compromise, compartment syndrome, and septic joints need same-day action, while most overuse problems can wait for a scheduled visit.
2. 2
   : Focused examination. Compare both sides, test range of motion, strength, stability, neurovascular status, and pain provocation. Document the exact findings in terms another clinician could reproduce, such as degrees of extension or a grade on a standard strength scale.
3. 3
   : Imaging and tests selected for the question. Order plain radiographs first for most bony complaints. Use magnetic resonance imaging when soft tissue detail will change management, and ultrasound when a dynamic or bedside look is useful. Avoid repeating imaging that has not changed the decision.
4. 4
   : Working diagnosis and options conversation. State the most likely diagnosis, the remaining uncertainty, and two or three options with their trade-offs. Record the patient's choice in the chart in the patient's own words where possible.
5. 5
   : Non-operative trial or operative planning. For conservative care, define the duration, the therapy prescription, and the reassessment date. For surgery, confirm the procedure, laterality marking, implant needs, anesthesia plan, and post-operative restrictions before the case is scheduled.
6. 6
   : Surgery and immediate post-operative care. Complete the time out, verify site and procedure, give antibiotic prophylaxis and venous thromboembolism prevention according to facility protocol, and document implant details and intraoperative findings. Provide written instructions for wound care, weight bearing, and warning signs such as fever, calf pain, or increasing drainage.
7. 7
   : Rehabilitation handoff. Send the therapist the operative report, the restrictions, the expected phase timeline, and the functional goals. Schedule the first post-operative review at a fixed interval so that wound checks and therapy progress are linked.
8. 8
   : Return to activity decision. Use measurable criteria such as strength symmetry against the uninvolved side, range of motion, single leg hop performance, and sport specific tasks, together with clinical stability. Document who made the clearance decision and the criteria used, including any tests that were deferred.

05Quality checks, risk controls and compliance

• Use a time out before every operative case and confirm laterality with the patient awake when feasible. Wrong site surgery is rare but preventable, and the controls are procedural rather than dependent on any one person's memory. Mark the site, check the consent form against the booking, and confirm implants against the plan.
• Track surgical site infection, venous thromboembolism events, implant related complications, unplanned return to the operating room, and reoperation rates. Compare results against your own service baseline and against relevant registries or published benchmarks that you have read and can cite accurately.
• Sports settings carry specific risks. Common ones include return to play before neuromuscular control is restored, inadequate concussion evaluation on the sideline, heat illness, and pressure to clear an athlete for competition. Write down the criteria used and the person who made the decision, and keep that record separate from informal sideline comments.
• Opioid prescribing, controlled substance handling, and mandatory reporting of certain injuries vary by jurisdiction. Confirm current rules with your licensing board, your pharmacy, and facility policy. Implant tracking and adverse event reporting follow federal rules and facility requirements in the United States, so check the current version that applies to your setting.
• This guidance does not replace qualified professional judgment, approved institutional procedures, or required authorization. Surgical decisions, anesthesia, and medication dosing must be made by licensed clinicians working within their scope and credentials.

06Collaboration and documentation

• The surgeon owns the surgical plan, but the case runs on a team that includes anesthesia, nursing, surgical technologists, imaging staff, therapy, pharmacy, scheduling, and, for athletes, the athletic training staff. Use one shared plan document so that changes are visible to everyone who acts on them.
• Documentation should answer five questions at every visit: what was found, what was decided, who decided it, what the patient was told, and when the next review occurs. Avoid copying forward unchanged examination findings from earlier notes, because copied text hides real change. Record laterality and implant identifiers exactly.
• Communicate with referring clinicians and team physicians in writing within a set time after a procedure or a major change in plan. For athletes, define in advance what information goes to coaches, athletic trainers, and parents, and what remains confidential. Those rules depend on jurisdiction and on whether the athlete is a minor.
• Privacy rules in the United States under HIPAA apply to most clinical communication, and state laws may be stricter. Confirm the local requirements with your privacy officer before sharing detailed records with coaches, employers, or schools.

07Measures and continuous improvement

• Choose a small set of indicators that you can collect reliably. Useful ones include time from referral to first visit, time from decision to surgery, the share of operative notes that are complete at discharge, patient reported function scores at fixed intervals, return to intended activity, and complication rates. Define each measure in writing before you start collecting data.
• Patient reported outcome instruments such as validated knee, hip, or shoulder scores are useful when they are used consistently at the same intervals. Switching instruments between visits makes trends meaningless. Pick instruments that have been validated for the body region and the patient group you treat.
• Review the data in a regular quality or morbidity meeting. Look at individual cases where something went wrong, and also at aggregate trends. Small numbers swing widely, so avoid changing practice in response to one unusual quarter. Look for patterns that repeat across several cases before deciding what to change.
• Measurement involves trade-offs. Collecting everything burdens clinical staff and can crowd out patient contact. Measuring only operative volume rewards speed over fit and can push borderline cases toward surgery. Balance clinical outcomes with patient experience, staff workload, and time to recovery.

08Common mistakes and how to prevent them

• Ordering imaging before the examination is complete. This leads to treating a picture rather than a patient. Prevent it by writing the examination findings first and naming the question the test must answer before the order is placed.
• Delaying the rehabilitation referral until the patient is already struggling. Send the referral at the first post-operative visit or earlier, with the protocol attached, so that therapy starts on schedule and early problems are caught.
• Clearing athletes by elapsed time rather than by criteria. A calendar date does not show strength, control, or readiness for contact. Use measured thresholds, a named clearing clinician, and a written sign-off.
• Vague consent conversations. Patients who hear only that a procedure is safe are often surprised later by the recovery. Use a written consent script, ask the patient to explain the plan back in their own words, and document the questions that were asked.
• Incomplete handoffs between surgeon, therapist, and primary care clinician. Use a standard handoff form that lists restrictions, medications, follow up dates, and warning signs, and confirm that the receiving clinician has read it.

09Practical checklist

• Confirm the clinical question and the pending decision before ordering any test.
• Review prior records, imaging on disc, medication lists, allergies, and earlier treatment.
• Examine both sides and document findings in terms another clinician can reproduce.
• Record the working diagnosis, the options, the trade-offs, and the patient's choice.
• Verify laterality, procedure, and implant needs before the day of surgery.
• Complete the time out and record intraoperative findings and implant identifiers.
• Send the operative report and phase based restrictions to rehabilitation before the first therapy visit.
• Use measurable criteria for return to activity and document who cleared the athlete.
• Track complications and patient reported outcomes at fixed intervals.
• Confirm current rules for opioids, reporting, and privacy with the licensing board and facility policy.

★Learning sources

• Micro Degree: Orthopedic Surgery and Sports Medicine
• Micro Degree: Healthcare Administration Practice
• Micro Degree: Physiotherapy Assistant Operations
• Micro Degree: Cardiac Care Support