Monday, September 26, 2011

Week 1 Wednesday

We started out Wednesday in clinic after our usual 730 AM morning meeting and making rounds on the hospital patients. Wednesday is clubfoot clinic day so there are always a lot of kids that come in with clubfeet that are starting or in the process of getting corrected through casting or a combination of surgery and casting. I saw the most severe clubfoot I have ever seen in a pre-teenage girl. She was in the process of correcting one side with the other side still showing the deformity. She was unable to walk on her own and had to be carried around by her father. 
Even though we are nearing 2 years out from the January 12th earthquake, we still see patients in clinic on a near daily basis with untreated orthopaedic injuries from the quake. One of our clinic patients had a non-union distal humerus fracture and had been unable to effectively use her arm since the earthquake. Because she was so far out from her injury, surgery to correct her fracture would be incredibly difficult and complicated. We tentatively have her scheduled for surgery this upcoming week, but if traumas come in or other cases don’t get done on their scheduled day, she may very well be bumped from the surgery schedule this upcoming week.
At the end of clinic, we had a trauma come into the emergency room. It was a 9 yo girl who had been the pedestrian in a motorcycle vs. pedestrian accident the day before and had broken her distal femur. So instead of doing the case we postponed the day before right after clinic, we added on an ORIF of the femur. I really  enjoy doing femur cases and this was no exception. The age range of this girl made the case challenging especially since we do not have flexible IM nails at this hospital. So we did an open reduction with a plate fixation and I got to drill through her femur! We ended that case and finally got to our guy who then ended up waiting all day NPO to have surgery again. The case ended somewhere between 12-1 am. By that time, we brought him to the ward and there were no nurses to be found to check in on him post-op. It took a while to wind down from the night and we finally ended up going to bed just before 2 am. 

bilateral club foot: R side in process of correction

humerus fracture from the quake

humerus fracture from the quake

me holding traction and the femur reduction

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