Orthopaedic Infections, Sickle Cell Bone Crises, Pathological Fractures, and Musculoskeletal Tumours — WACS Viva & Clinical Scenarios (Orthopaedics & Trauma)

Exam-style orthopaedic infections, sickle cell bone crises, pathological fractures, and musculoskeletal tumours viva scenarios with examiner probes and model…

Scenarios covered

• SCENARIO 1: A 21-year-old male (ASA 3) with Sickle Cell Anaemia (HbSS, steady-state Hb 7.8 g/dL) is scheduled for elective total hip arthroplasty for Stage IV avascular necrosis of the femoral head. Outline your complete perioperative management, detailing preoperative haematological preparation (transfusion targets), intraoperative physiological controls to prevent sickling, surgical tourniquet considerations, and postoperative analgesia.
• SCENARIO 2: A 16-year-old female (ASA 3) presents with a massive distal femoral osteosarcoma measuring 25 cm in diameter. She is severely cachectic, pale (Hb 6.5 g/dL), and has serum calcium of 3.3 mmol/L. She is booked for an urgent above-knee amputation. Detail your preoperative resuscitation (including hypercalcaemia correction), intraoperative anaesthetic plan, and management of phantom limb pain.
• SCENARIO 3: A 52-year-old male (ASA 3E) with poorly controlled Type 2 Diabetes presents with gas gangrene and necrotising soft-tissue infection of the left lower extremity tracking up to the mid-thigh. He is in septic shock (BP 80/45 mmHg on dopamine infusion, HR 130 bpm, lactate 4.8 mmol/L, blood glucose 24 mmol/L). How do you optimise, anaesthetise, and manage this patient for emergent hip disarticulation / guillotine amputation?
• SCENARIO 4: A 9-year-old boy (ASA 2) with chronic osteomyelitis of the femur is scheduled for radical sequestrectomy and saucerisation. He has been on prolonged antibiotics, is underweight, and has a fixed flexion contracture of the knee. How do you assess his nutritional/inflammatory state, provide intraoperative anaesthesia, and establish effective multimodal postoperative pain relief?