Hands on Education

20 June 2013

            Jaclyn and I were back shadowing Dr. Pelser today, except this time we scrubbed up and went to the operating room! We were at Pelonomi Hospital, which is another state hospital located about a 15 minute drive from campus. Before I get to the surgery, I wanted to give an update on the young boy with the deformed index finger. Dr. Pelser is going to wait for an MRI to get back to him before making a decision because he is not sure if the defect is congenital. As for now, Dr. Pelser believes that the boy’s hand will function better if the finger is amputated.

            Alright now on to the cool stuff. Our first patient had a fractured ring finger on his right hand that was completely displaced. The fracture occurred at the first phalanx (finger bone between the knuckle and first joint). A metal plate was screwed into the bone on either side of the fracture, bringing the fragments together in their proper alignment. This immobilizes the bone so that it can heal while still allowing the joints of the finger to move, so no stiffness occurs in the finger. The patient can begin moving his finger as early as tomorrow, but I got a feeling it’s going to be a little sore for that.

            We saw an interesting case in the operating theatre next door to us. A boy of about five years old had a severely deformed right leg and foot. The foot itself was angled to the left almost 90 degrees from normal. In looking at previous x-rays, the boy was born with loss of bone from his right tibia. In a previous operation, a bone graft from his left fibula was performed to fill the hole in his tibia. The x-rays also showed the bones of his ankle to be deformed and some were fused together. During today’s operation, the boy was undergoing a muscle and skin graft for the inside area of his deformed right ankle. Specifically, a piece of his gastrocnemius (calf) muscle and skin was taken from his left leg to be used for the graft. The operation was successful and after he heals, then the doctors will perform another operation to reconstruct his ankle so that he can walk.

            Our second patient had a combo order. He had a scaphoid (bone in the wrist) fracture, as well as a fracture on the neck of the radial head. Apparently the rule about the scaphoid is that if you can easily see the fracture on an x-ray, then surgery is advised. It was an easy fix in which a guide wire was first inserted into the fracture, and then a compression screw was used to bring the scaphoid together so it could heal. The fracture on the neck of the radial head was a bit more involved. The fracture caused the radial head to fall out of perpendicular alignment with the humerus in the elbow joint. A plate was screwed across the fracture to correct the alignment of the radial head. At first, Dr. Pelser attempted to move the radial head in the joint and you heard a terrible popping sound and it appeared as if the elbow was dislocating. After some minor readjustments, the elbow was in proper working order and the patient was on his way to recovery.

            Our third and final patient had a fractured fourth metacarpal (bone in the back of your hand attached to the knuckle of your ring finger) on his left hand. Unfortunately the patient did not present the fracture to a medical professional until three months after it originally occurred; therefore, the bone had healed incorrectly. The bone had healed at an angle so that it looked like he had an extra knuckle poking out the back of his left hand. In order to correctly realign the bone, a wedge was chiseled out where the bone had healed at an angle. A plate was then screwed across the fracture, bringing the fragments together in their proper alignment. The space between the fragments was filled with pieces of bone from the wedge that was taken out, allowing the bone to heal more effectively.