There are some important tests that every Orthopaedic
Surgeon should think about. This doesn’t mean the tests are needed for every
patient. It just means that the physician needs to think about these tests to
see if it will benefit the patient or not. Some tests commonly ordered are
hemoglobin A1C (HbA1c), Vitamin D25, and C-reactive protein (CRP) &
sedimentation rate.
Hemoglobin A1C test are ordered for diabetic patients. HbA1c
is a good test for monitoring long-term glucose (sugar) control on patients with
diabetes. HbA1c is a percentage of the glycanated hemoglobin relative to the total
hemoglobin in the blood. The normal range of HbA1c is 4-6%. More than 7% is
high. Another test, the 25-Hydroxy Vitamin D blood test is ordered for patients
with osteoporosis, nonunions, fragility fractures, and occasionally in patients
with infections. If infection is suspected and the physician needs to monitor
the progress of treatment, C-reactive protein (CRP) & sedimentation rate
tests should be ordered. A Methicillin-resistant staphylococcus aureus (MRSA)
screening should be ordered for patients who could be carriers. Nutritional
assessments may be necessary for other patients.
Joints should be aspirated prior to injecting of the joint.
The physician should additionally be sure that there is no infection when
injecting the joint. A fluid analysis from the joint should be completed.
Important vascular studies that can be ordered include: A.B.I., CTA, or a
Doppler. Some radiological studies are performed with a dye injection. For
example, an MRI of the spine will require gadolinium, while an MRI arthrogram
may be used for the hip or shoulder. Tests rarely ordered include: alpha-defensin
test (infection); Nicotine/Cotinine test (smoking); Protein S, Protein C, or
Factor 5 leiden tests. There are some special tests and precautions that must
be taken for patients with epilepsy. It is important that the physician does
not perform a procedure if the epilepsy is not controlled. It is important to
know that anti-epileptic medication can interfere with vitamin D metabolism in
the liver.
Patients on anticoagulation medications should be monitored,
especially patients with atrial fibrillation, which makes the orthopaedic
procedure more complicated. You want to give the patient anticoagulation, but
not encroaching on the management of atrial fibrillation. Patients with a short
or thick neck, or a history of sleep apnea, may need additional sleep studies before
surgery and may need special precautions after surgery. Sleep apnea will affect
the post-operative care of the patient. The physician should avoid ordering unnecessary
tests and focus on ordering the most important tests. Orthopaedics deal with
concepts and every condition will have a reasonable way of diagnosing it and a
reasonable way of treating it.
