P4R3W5: The Trimalleolus fracture

It was another good week up on 5th floor, NMDHB physiotherapy outpatient clinic.

Here are my top three small successes of the week:

1. I discharged a couple of clients who I assessed and managed from day one. For one with of these clients with shoulder instability, I even sent a letter to the GP advising them of our treatment findings and outcomes.
2. My chronic non-specific whole back pain client had some great success in the hydrotherapy pool. We're making progress in leaps and bounds... small bounds.
3. I'm assessing and treating patients independently, mostly. I'm still giving a debrief of assessment findings and treatments to my supervisor after each treatment. I'm happy with my supervisor listening through the curtains too and hearing the odd voice pop up to tell me things. Also, the other physical therapist has a good listen in too and will often pop her head through the curtain to have a good chat with clients she's seen before.

Our two hydrotherapy sessions are given to eight people per session. Patients work on their own programmes or follow a orthopaedic protocol such as for a knee replacement or a hip replacement. I'm currently looking after 2-3 clients per morning session on a Thursday. I've discharged a client from the pool session. They had a knee replacement. This person had achieved their goals, managed their pain so well that it was no longer a problem and could flex their knee to ~120 degrees and fully extend their knees. They were physically active and were now using the public pools twice per week. Perfect! They were very happy to have had the chance to use the hydrotherapy pool, describing it as 'wonderful' and 'heaven'!

On Thursday I had a peer come in to watch me assess a new patient. Yes, it's peer assessment time again! I had an older person with neck pain, spondylosis. I thought it went very smoothly. So now I've got some paper work to do, and some reflections to make about experiences had on this placement so far - I'll have to put my thinking cap on!

Friday in ED was great. One interesting case was of an older person with osteoporosis on holiday in Nelson. This person tripped and fell on a step causing a bi-malleolus fracture of their left leg. The doctor actually called it a tri-malleolus fracture because the posterior tibia also had a fractured fragment. Having googled trimalleolus fracture, I've discovered that it is actually a term used. I thought the doctor simply had a good sense of humour! Anyway, I was allowed to help put a cast on - by holding the leg. Small job, but important! haha! This person was having a good old laugh and was upbeat throughout my assessment process and was still upbeat some hours later when we had an orthopaedic consultation and tested their mobility on crutches, then opting for a frame when they realised that the cast was very heavy. Patients like these make the hours fly-by... probably not for them though.

I've had a couple of DNA's this week (did not arrive), which is a bit disappointing given that there is quite a few people on the waiting list who may have benefited from that timeslot...

This Saturday is a social outing for those keen NMDHB physios - Indian food at Indian Cafe in Nelson. I'm planning on heading along for that.

Two more weeks to go!