On Wednesday and Friday, I spent long days in the operating room. Wednesday consisted of three cases. The first was an irrigation around a hip prosthesis due to a suspected infection. I could not see a lot of the action because the patient table was pretty high up but specimens that were being sent to pathology looked fairly irregular. Some black 'gunk' mixed in with the blood. Irrigation also proved to be a messy procedure, forcing me to designate a 'splash zone' that I would not cross to get a better look. The device being used essentially pumped saline into the desired site after contamination was removed/suctioned away. It would be neat if the surgeons could do this work through some sort of sheet so that there wasn't much splash-back. Maybe a perforated one that has accessibility points for the various instruments. The next surgery was a proximal humerus fracture corrected by open reduction-internal fixation (ORIF). The patient needed a fibular graft placed along the lateral aspect of her humerus before adding the fixation components. These consisted of a plate fixed by a number of screws that were directed lateral to medial near the diaphysis and inferior-lateral to superior-medial around the humeral head. Dr. Lorich came by the operating room and gave Dr. Lane some advice for getting the plate more flush with the bone. I'm not sure why. Maybe it was his lunch break or he was just bored and checking in. Either way, it was interesting to see two very knowledgeable surgeons discussing strategy. The last surgery was another irrigation case because the patient was thought to have a bad reaction to polyethylene wear particulates from her hip prosthesis. This hypothesis was confirmed upon opening up the affected area. The unidentifiable 'gunk' being removed was thoroughly odious but surprisingly not nauseating. I think at that point my mind started racing as to how an immunological response could create these substances/solids rather than what they actually were. On that note, I may follow-up with Dr. Lane or the orthopedic fellow to find out because pathology testing should be done.
I could keep my notes on Friday short because this blog post is reaching my usual length. Instead, I'll keep it short because Friday surgeries were a little bit redundant. I had already seen a kyphoplasty and Friday included two more. The real excitement is when the whole OR can't get the cement mixing device to work. For the second procedure, Dr. Lane put me in charge of pressing the buttons. Which essentially meant pushing one button. Still, it was nice to have a role outside of just watching. I also got to observe some stitching up by the orthopedic fellow. It definitely takes some quick hand movements and I imagine he's had plenty of practice at it by this point. It was also something he allowed the scrubbed-in medical student to practice which I thought was very cool because that is exactly the type of experience that they should be getting in the OR.
Clinic got a bit redundant this week too. While there are unique fracture cases, and even a new osteosarcoma patient, many of the patients are osteoporotic and set to receive a fairly standard drug regimen. Yet, I did get to see the extendable prosthesis patient I'm doing the case study on. He came in for his occasional lengthening and I got to interact with two gentleman from Stanmore that help set up the devices for the procedure. Again, the patient doesn't feel anything and is able to go about his daily business as if nothing happened. In the words of Larry David, prettaaaay prettaaaay prettaaaay good.
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