A Crazy Day. . . .

Wow!!  What a whirlwind today was!  Wednesdays are our one clinic day where we see all the orthopedic patients.  It's usually very busy, but today was exceptional in many ways, and I feel the need to share it.  For starters, we saw 106 patients.  That's two-three times as many as anyone sees in the states in a day!  We were flying!  It's non-stop chaos with some difficult and strange pathology mixed in.  It makes for an interesting day.

This is a chest x-ray from an unfortunate 13 year old boy that presented to Tenwek with 4 days of fever and right thigh and knee pain with an inability to walk.  For an orthopedist, those symptoms always mean some kind of infection, either in the knee joint, the bones (femur or tibia) or the muscles of the thigh.  Regardless, it's not good.  The child was so ill from this infection that he was in sepsis, meaning his body was in a super inflammatory phase trying to deal with thy bodily infection and on the brink of shutting down.  He was emergently taken to the OR to drain the pus from around his knee and was admitted to the Pediatric ward for close monitoring and IV antibiotics.  His condition continued to worsen over the course of the day and he was eventually transferred to the ICU.  His chest x-ray below shows multiple, patchy spots indicative of spots of infection within his lungs.  It's probably a widespread Staph infection that started in his femur and has spread throughout his body.  He's touch and go now, and I hope and pray that the antibiotics do their job and he turns the corner.  You can keep this boy in your prayers with us.

This next case is also a very sad one.  This gentleman is 54 years old and recently had a surgery for prostate cancer.  He also recently developed a fracture of his right hip for which he was referred to us.  Looking at his x-ray today, it was obvious that his entire pelvis and both hips are consumed with cancer.  Not only did I have to break the news that there was nothing that we could do to help his fracture but also that he had widespread metastatic cancer that couldn't be treated.  It was a somber moment for all involved.  I did have the opportunity to pray with the man though, and I found out that he is a believer.  In a situation like this, sometimes the hope of the Lord is all you can offer a patient.

The next big event of clinic was when a lady with an ACL tear arrived to clinic.  The hospital has a arthroscope to do arthroscopic surgery, but none of the surgeons who operate here are familiar with arthroscopy.  She's been waiting for someone to come here who can do her surgery.  By the providence of God, she randomly showed up today!  After checking with the OR to make sure that the appropriate equipment was available, we booked her for a knee arthroscopy and ACL reconstruction for next week.  I'm so excited to be blessed with the opportunity to help this lady out and teach the locals about arthroscopic ACL reconstruction. 

To top off the day, the very last (106th) patient of clinic rolled in after an accident earlier this afternoon.  He had a tibial plateau (ie. the top of the tibia) fracture and had an obvious compartment syndrome.  Compartment syndrome is when there is an injury to a body part (in this case a leg) that causes so much swelling in that part that the pressure gets so great that it restricts blood flow (to the foot in this case).  This guy had obvious symptoms of compartment syndrome and even no pulses in the foot (which is usually the last thing to go).  This is one of the few true emergencies in orthopedic surgery.  He was rushed to the operating room and underwent fasciotomies where the skin and deep tissues are cut to release the pressure.  Thankfully, by the grace of God, his pulses immediately returned.  We still have a very difficult fracture to fix in the near future but at least he'll hopefully keep his foot!

So, that's just a little of the excitement from today.  Maybe it's not interesting to the non-medical folks out there, but I'll share it just the same.