Upcoming cases. . . .

Here is just a sampling of the cases I have waiting for me this Monday.  Not much happens over the weekend except emergencies and washouts of open fractures.  A lot of the cases so far seem to be "cold" trauma, meaning they are remote injuries in various stages of healing and not acute or fresh.  That makes fixing them a little more difficult as healing and scarring have already begun and we have to resort to more salvage and reconstructive procedures as opposed to trying to make them normal again.

Here is a bimalleolar ankle fracture in a 58 year old diabetic.  Normally not too big of an issue, but this one is malreduced (out of place) and is 11 weeks old.  While we would typically fix an acute fracture with plates and screws, this chronic injury is not amenable to such fixation, especially in a diabetic.  I'll probably have to go ahead a do an ankle fusion which is his best chance to have a stable, pain-free ankle with the least risk of infection or other complication.



This next one is a 35 year old male after an automobile accident with a distal femur fracture.  This is pretty straightforward and easily treated in the US with a combination of lag screws and a locking plate.  However, we don't have distal femoral locking plates here so my fixation will have to be a little creative.  We'll see. . . . 

Here is a typical hip fracture in an elderly patient.  Because of the degree of displacement of the fracture in the left hip, the blood supply to the femoral head (the "ball" of the ball and socket joint) has been disrupted and it will eventually die, leading to early arthritis.  Therefore, the only option is a partial hip replacement in which we remove and replace the ball with a metal one.  There are implants for this operation here so that's what we'll do.  For the orthopods reading this, it's the old Austin-Moore prosthesis.

This guy was attacked by a man with a panga (Swahili for machete).  He has open fractures of his left elbow and ulna.  He also has an injury to his ulnar nerve on clinical exam.  Considering the mechanism of injury, it's likely a laceration to the nerve and not a crush injury.  Therefore, the nerve may be amenable to repair.  I will likely fix the elbow with a tension band, plate the ulna and explore and possibly repair the nerve if feasible.

So there you go, just a smattering of what's in store for me during my time here.  It should be interesting.