Physical Aspects

Most T&O procedures do not require brute strength – it is often worth noting that if excessive strength is required that something needs to be adjusted rather than hit harder! However it is a more physical speciality than some. The following techniques might be helpful:

Remember to always follow your local moving and handling procedures where appropriate!

Stamina

• Don’t worry stamina will develop overtime. It is not uncommon for beginners to find even the process of scrubbing tiresome on the Deltoids, but your strength and stamina will improve over time.

Strength

• Women are typically less developed than men in the upper body and shoulder girdle this can be combated by:
  • Anchoring your elbows to your sides to hold something at waist height.
  • Locking elbows, use both hands and form a tripod when holding something higher e.g. the leg when prepping.
  • Use your body weight, standing stools can help to allow you to position yourself in a place to lean in rather than use your muscles e.g. pressurisation of acetabular cement and fracture reduction.
• Archimedes could lift the world with a lever – don’t forgot these principles; f x d – so increase the distance to reduce the force required.
  • Cutting thick K-wires – place the wire in the furtherest (sharp) area of the jaws from the pivots and similarly your hands at the very ends of the handle.
  • If using retractors as levers hold them at the very ends.
  • Use supports as pivots when reducing fractures.
• If you are tiring try shifting your position to recruit a different group of muscles;
  • Rotation of the forearm / shoulder will move the intensity of the work
  • Swap hands
  • Standing side on or partially and swapping sides
  • You will still need to be mindful at points where being still is essential e.g. while cement is setting, holding tricky fractures in place.
• Get help!
  • If you are battling against muscle tone ask the anaesthetist to use muscle relaxant.
  • Some procedures just require 2+ people – a below knee back-slab requires 3 for example!
  • Take turns with the people you are scrubbed with.