Friday was our last operating and clinic day at the Adventist Hospital and, per usual, was scheduled to be very busy. We had originally scheduled 2 cases - placing a SIGN nail in 2.5 yr old tibial malunion (the guy had broken his tibia 2.5 yrs ago and healed it, but healed it poorly) and a hip hemiarthroplasty with an ORIF of a distal radius fracture on a guy who was referred to us from another hospital - his fractures were only about 4 weeks old. His surgery was dependent on whether or not his family could get blood for him. Sad to say that 4 weeks seems like a short amount of time for coming in to get fixed when in the US, these both would have been fixed surgically at the time of the trauma. We had also pushed the SIGN nail of a femur onto Friday because of the blood fiasco. So we had three big cases scheduled when we started our rounds Friday morning. After morning rounds, we added on another case of an in-house patient with suspected osteosarcoma. After Pat heard back from one of the ortho tumor guys in Minnesota, we decided to do an incisional biopsy of her soft tissue mass to confirm a diagnosis. This is supposedly a small case, but in Haiti, no case is really that small as everything takes about twice as long to do. As Pat Ebling, Paige, Kris, and I were getting ready to start the tibia case, Pat Yoon added another case on from clinic - an external fixator adjustment with a pin and strtut change. Looked like it was going to be a long night.
In order to correct the tibia malunion and place a SIGN nail, we had to rebreak his fracture site and cut out the new bone formation in order to get to bone canal so that we could ream out the canal in order to place the nail. Healed bone is incredibly hard so this part of the case took over an hour. Once we got the improperly healed bone out, the rest of the case went fairly smoothly for getting in the SIGN nail.
We had a quick break for a snack then moved on to the incisional biopsy around 1230 that afternoon. After making a small incision, we realized the mass in her thigh was actually a cavitary mass filled with old blood and necrotic tissue that, from Pat Ebling's experience, did not look like osteosarcoma. We got a tissue sample that Pat Yoon has since taken back along with a CT scan (which he paid for out-of-pocket) to the US for evaluation.
During this time, the correct blood for our femur patient had arrived, so we took a mid-day break for lunch since we knew this SIGN nail would be a long case. His original fracture was over 8 months old and although he didn't have bony healing to cut out, he did have some overlapping of bone and soft tissue contraction that would be difficult in getting the fracture site reduced. Pat Yoon was finished with clinic at this point so both Pats, me, and our local surgical tech JJ scrubbed in for the case. The case had no major complications although we were very thankful we waited for blood as our patient bled more from the surgical sites than any patient I had ever seen. He received one unit intra-op and one unit immediately post-op.
After getting all our patients tucked away for the night, we headed to the Auberge with JJ and Alex (one of the long-term volunteers) to celebrate our work for the week and as a send-off to Pat Ebling who was leaving Saturday morning. During our late night dinner, Pat Ebling talked about his experience with MSF. Someone had told him that there are two groups of people who work with MSF - the rookies and the addicts. I think the same could be said for our trips to Haiti. Pat Yoon, Paige, Tom, Amy, and me are all addicts and I think our rookie team members may soon be joining our ranks.