PRE OPERATIVE PROCEDURE

Should Dr Mulder recommend scheduled surgery, our practice will give you all the information your medical aid needs to green-light the admission and procedure. Please pass this information on to them so that they can issue you with an authorisation code.

We will also direct you to the Pre admission Clinic within the MediClinic Constantiaberg hospital. They will handle all the necessary paper work, which results in a speedier and smoother process on the actual day of surgery. The Clinic will also check your vital signs and should there be any problems or concerns, they will be addressed before your operation.

Our practice will also tell you:

  • What time you need to arrive at the hospital for admission, and an estimate as to what time your surgery will take place.
  • What time you must stop eating (nil per mouth). An anaesthetic can only be safely given 6 hours after you last had something to eat or drink. As a general rule when surgery is planned for the morning, you will be asked not to eat (or drink) after midnight the night before your op.

Day of admission

Please report to the front reception desk of the hospital where you will be admitted and directed to your ward.

Timings

We completely understand that going in to hospital is a time of anxiety for both the patient and the family. Which is why we do our best to make the process as professional and orderly as we possibly can. Having said that, surgeries can take longer than expected, so please be understanding if your procedure is delayed. We will keep you informed if it looks like we’ll be running late.

ADDITIONAL NOTES

  • Even if your surgery is planned as a day procedure, you must arrange for a lift to and from the hospital. It’s not safe to drive after an anaesthetic.
  • Please bring all your regular medications with you to hospital. If possible, bring the packaging as well as the actual meds so that we can issue additional medicine from our hospital pharmacy if necessary.
  • If you use any blood thinning medications such as Aspirin (Ecotrin) or Warfarin these need to be stopped well in advance of surgery. Please contact the practice for more information about this.

SPORTS INJURIES

The majority of sporting injuries will settle with rest, ice, elevation and some form of compression. However if these remedies don’t resolve the injury, physiotherapy and specialist assessment may be necessary.

Dr Mulder has vast experience in the diagnosis and management of upper limb sports-related injuries. He works closely with the treating physiotherapists in order to monitor a patient’s recovery process and will identify if surgical intervention is necessary.


RETURN TO ACTIVITY FOLLOWING A FRACTURE

Q: How long will it be before I can get back to “normal”?

A: The time frame varies from person to person, as every injury is as unique as the person who sustains it.


THE HEALING PROCESS

Injuries are frustrating and naturally patients are eager to know when they can expect a full recovery. The time it takes for the fracture and associated soft tissue or “non boney” injury to heal is influenced by a number of different factors.

In order for to assess a patient’s individual progress, Dr Mulder will ask detailed injury-specific questions and perform an examination that is often supplemented by X-rays or other necessary scans. This information is then interpreted to inform and create a guideline for returning to day-to-day activities (personal hygiene tasks, driving, lifting), work related tasks and sporting activities.

Depending on the injury Mike may prescribe a rehabilitation programme that is supervised by a physiotherapist. Over the course of the treatment the therapist will provide ongoing feedback to him regarding the patient’s progress. The end goal: getting the patient mobile again as quickly and safely as a possible.

Given that no recovery programme fits all, it’s best to discuss specific agendas with Dr Mulder.


WOUND CARE

Whether acquired through injury or surgery, wound care is vital. A well cared for wound goes a long way to avoiding unnecessary complications that may negatively impact the healing process.

Before being discharged, our practice will give patients a set of instructions that detail how to care for their wound. One of the most important things they should know about their dressing is whether they can get it wet or not. Some dressings have to stay dry at all times.

FORGOTTEN YOUR INSTRUCTIONS?

If you’ve forgotten what you were instructed or are in any doubt about the specific “do’s and don’ts” of your wound care, please contact the practice. Sister Seona is able to answer most queries and if any doubt exists, she will contact Dr Mulder for clarification. Rather ask us than risk slowing your recovery process.


SIGNS OF INFECTION

If you develop any of these following signs, please contact the practice for further evaluation. Early detection is important.

  • Redness
  • Increasing pain despite using the prescribed painkillers
  • Increasing swelling
  • Throbbing
  • Discolouration on the dressing
  • New bleeding
  • Foul smell

NOTE: if you suspect that there is an infection, do not start any antibiotics without first consulting Dr Mulder. Antibiotics may mask important signs and delay the appropriate treatment.


PIN CARE

Depending on the type of the injury, smooth pins may be left sticking out of the skin or they may lie below it. Pins that stick out through the skin will be covered with a dressing and a splint or with a cast. It’s a very important part of the healing process to keep these coverings dry. If you’re at all worried about the site where the pins penetrate the skin, please contact Dr Mulder at the practice. He is only too happy to answer your questions.


PLASTER CARE

NOTE: While these instructions are written for the care of children’s plaster casts, the guidelines below are relevant to adults too.

General instructions

Elevation: During the first 48 hours after the cast has been applied, keep your child’s arm raised above heart level (with fingers pointing up) and encourage your little patient to move the fingers which helps to reduce the swelling. When your child is sitting or lying in bed, prop the limb up on pillows. Slings are not routinely issued.

Possible warning signs

Please keep an eye out for the following signs – especially in the first 48 hours:

  • Swelling that is excessive or that’s getting progressively worse.
  • Pins and needles, tingling or burning in the fingers.
  • Numbness or loss of feeling.
  • Inability to move fingers.
  • Pain beneath the cast, which is severe or getting worse, or doesn’t improve with painkillers (some discomfort beneath the cast from the fracture is normal).
  • For young children who can’t communicate – excessive irritability may suggest problems with the cast.

If any of the above symptoms occur, elevate the limb for 20 minutes, administer painkillers and encourage finger movement. If the symptoms don’t improve, contact Sister Seona at the Practice during office hours on 021 797 9141 or the Emergency number after hours on 082 607 4666.

Skin care

Please don’t let your child push objects down the cast (e.g.: rulers, knitting needles, pens, etc.). These may damage the skin and lead to the formation of sores.

If you suspect that there is something under the cast, let us know. Signs that there may be a problem include liquid staining of the plaster or oozing – i.e. yellow or green fluid. It is normal for casts to develop a perspiration odour, particularly if they’ve been worn for a few weeks.

On that note, also resist the temptation to put talcum, or perfumed powders, down the cast to reduce the smell; nine times out of ten they only make it worse.



Plaster care

Please don’t cut, or try to modify, shorten or remove the cast yourself. If a section of the cast is irritating the skin, please give us a call at the practice and we will make a plan from there.

Repeat x-rays

In cases where fractures are unstable Dr Mulder may ask you to repeat x-rays to confirm the position of the bones. These can be taken through the cast.


LIMB CAST ADVICE SHEET

NOTE: While these instructions are written for the care of children’s wet and dry limb casts, the guidelines below are relevant to adults too.

The purpose of a cast is to hold the bone in alignment while it heals (knits). The specific cast applied will allow safe movement of the limb, but will prevent movement of the fracture.

There are two main types of casts: those that can get wet and those that can’t. Depending on the type of cast your child has been fitted with – you will need to follow a set of very specific instructions. This is very important, as it will encourage a fast and trouble-free healing process.



- WET CASTS

If your child has been fitted with a cast that can NOT get wet, please follow these instructions very carefully. If you can’t remember whether your child’s cast may or may not get wet – please phone the practice for clarity.

Bathing
Wrap the arm in a plastic bag (sealed with adhesive tape) but do NOT submerge it in water. Although the hard synthetic plaster shell won’t be damaged by water, the padding won’t dry and may lead to sores developing beneath the cast.

Q: What if the cast does get wet?

A: Let it dry in the sun or use a fan blowing cool air only. Do not heat the cast.

- DRY CASTS

If your child has been fitted with a cast that can get wet, this means that the hard (coloured) synthetic plaster is waterproof and will not be damaged or deformed by water. The protective padding under the plaster is a non-absorbent synthetic material.

Bathing & swimming
Your child may bath, swim or completely immerse the cast in water 24 hours after the cast has been applied. Once wet, the water under the cast needs to run out. Let the arm hang by the side for at least 5 minutes until all the water has dripped out. This is important as any water trapped under the cast may cause damage to the skin.