Broken

Well I have had enough orthopedics for awhile...

My time here has reaffirmed that I have found my true calling in general surgery and I am happy and at home operating in the abdomen. Partly this is because of the plasticity of the organs involved - infected or injured portions can be removed, healthy segments can be reattached and back to normal use in days. For example, a 12-year-old malnourished girl can arrive with a distended abdomen and four days of vomiting and a big scar down the middle of her abdomen. She or her mother will not know (will not have been told) what operation was done in the past. But, if you remove the chronic and now obstructing stricture of her small intestine (stripped of it’s blood supply in a prior bowel resection operation) and reattach dilated but healthy small bowel back together with her colon, she can be eating well within three days and asking to go home.  

However, if someone broke their leg last year and they were casted in a non-functional way or, worse, instrumented with hardware that is now infected or that didn’t result in healing - the correction isn't so straightforward or complete and certainly takes a whole lot longer. 

If they have osteomyelitis in every extremity like the boy in this picture (an all too common bone infection in the setting of malnutrition, poor hygiene and limited health care) - now you have mess on your hands. 

In many scenarios - for example when their joint hasn’t moved for years -  there is nothing you can do to fix it, even if you work at the Hospital of Hope. Giving this disappointing news is hard and is taken hard.

There are many examples of ingenuity and tenacity that you see in orthopedics though and it does appeal to that inner construction Mr. Fix-It part of you (though I left most of that part of me behind on roofing jobs during my Huber Construction days). 

There is also an amazing company call SIGN that has developed a system to place intramedullary (through the hollow marrow portion of the bone) nails in fractures in resource settings like ours. In response to reporting of data and outcomes by hundreds of such hospitals, this company generously provides the nails free of charge (http://signfracturecare.org). We have already placed several of these nails in my brief time here.

Thankfully we haven’t had any falls from mango trees in awhile - hopefully they are all picked for the season. Here is the boy and his dad who I mentioned in a prior post - at a clinic follow up visit. There is definitely a bright and rewarding side to the care of orthopedic injuries.