Sunday, September 25, 2011

Playing Catch-Up: Tuesday

Tuesday was a first full surgery day. There were 6 patients scheduled for surgery and we knew it was likely that we would not get to all of them that day. It’s always difficult to prioritize the order of surgery knowing that the people scheduled for last would likely not have surgery and those near the end might be NPO all day and still potentially not have surgery. The morning started with a couple of cast changes under anesthesia on children with clubfoot. We then did a knee manipulation on a child who had a severe leg length discrepancy that was in the process of being lengthened. Lengthening involves surgically breaking the femur and placing an external frame that is cranked a little each day so that over time, the two ends of the bone are pulled farther apart and new bone forms in between thereby lengthening the bone and correcting the limb length discrepancy. During this process, the child’s leg had become quite stiff in the past week so we took him to the OR to try and loosen him up. This was followed by a break for lunch (rice and beans - big surprise...) and back to the OR. In the afternoon, we fixed a  2-week old distal radius fracture in a kid with an open reduction and percutaneous pinning. It was the first time I had pinned a radius. Definitely a challenge, but I was finally able to get the pin in place to hold the reduction. Our final case of the night was a hemiarthroplasty for a hip fracture. The local orthopaedic surgeon, Dr. Alexi, scrubbed with Pat on the case, so I observed and helped out around the OR as circulator/anesthesia assistant/xray tech. This case presented a huge challenge because the woman had a narrow femur, narrower than our smallest stem of our hardware available. Unfortunately, trying to place a the hardware in a too narrow canal led to cracking of the femur in two places. At this point, the head of the femur was already removed and we had to make something work. Thankfully, we found a smaller prosthesis in a secret stash kept by one of the other orthopaedic surgeons who has spent some significant time at this hospital. In order to prevent this woman’s femur from cracking further, wire was placed further down the bone. She was closed up and discharged from the hospital a few days later doing very well. 
This took us to the end of the night (around 10 pm) and I had to tell one of the patients who had been waiting all day for surgery that we were not going to get to him that night and he was finally able to eat after not eating all night. We told him he would likely have surgery the next day and could eat breakfast but nothing after that and we would hopefully do his surgery after clinic in the early afternoon.

Hemiarthroplasty (Dr. Alexi, Pat, Tom)

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