Nothing Like a Good Handshake for First Impressions

21 June 2013

            Today I went solo and shadowed Dr. Vom, who is an orthopedic surgeon and works in the same group as Dr. Pelser. Dr. Vom was performing a latarjet procedure. I had heard the term several times over the past few weeks and had a basic idea about what the procedure was all about, so I was excited to see the procedure first hand. Little did I know how up close and personal my learning experience was going to be.

             My first hint should have been when Dr. Vom told me to scrub up with him. My previous experience of going into the operating theatre has consisted of me putting on scrubs, mask, and hair net only to watch at a distance. So when I was asked to “scrub up,” I was completely lost. Thankfully, the nurse (they are called “sisters” in South Africa) was willing to coach me through the process. After tying on my hair net and mask, tightening my protective glasses, washing my arms and hands (a much more thorough process than it sounds), dawning a sterile gown, and putting on two layers of gloves, I was finally fit to take my stand at the operating table.

            The latarjet procedure is performed when a shoulder has been dislocated and a piece of the glenoid (part of the scapula that forms the socket of the shoulder joint) was chipped off during the dislocation. When the glenoid is chipped the socket does not appropriately cup the head of the humerus in the shoulder joint; therefore, the integrity of the shoulder joint is compromised, making the joint more susceptible to future dislocations. In the latarjet procedure, a bone graft is performed to fill the chip in the glenoid, so as to reestablish the structural integrity of the socket of the shoulder joint. In our procedure, the graft was taken from the coracoid process (extends forward from top, outer edge of scapula to stabilize shoulder joint).

            When I got up to the operation table, Dr. Vom had already cut down to the shoulder joint between the deltoid and pectoral muscles. This exposed the coracoid process. OK so thus far, I’ve just been watching, then Dr. Vom says, “Here hold this” and puts the patients arm in my hand. Then he breaks out the bone saw and tells me to pull on the arm to open the shoulder so he can get a good position on the coracoid. So there I am pulling on the patient’s arm, thinking, “No way is this happening.” Then Dr. Vom starts up the saw and goes to work, all the while I’m trying to hang on to this arm so it doesn’t move and Dr. Vom goes sawing on something he shouldn’t. Liability issue? “Ain’t nobody got time fo dat!” It was awesomely terrifying holding on that arm, feeling the tremors from the saw reverberating down its entire length and into my hands. That was probably one of the most intense moments of my life.

            The coracoid was cut free from the scapula, but it still had muscle attached to it. Dr. Vom then cleaned the surface of the coracoid to prepare it for grafting. Then he took it between the fibers of the subscapularis tendon and screwed it into the glenoid where it had chipped. In this way, the muscles left attached to the coracoid stabilize the shoulder joint, and the supscapularis tendon further stabilizes the joint by acting like a sling.