Monday, August 01, 2005

Tunde - 3rd week

Interesting surgery
Scheduled to observe a surgery with a certain surgeon, I arrived that the OR, dressed appropriately and inquired about the surgeries scheduled for the day. But on getting to the appointed room, I was informed that the first surgery for the day was cancelled, so I had to hang out in the lounge till the next patient was brought in. On getting to the lounge, I met a friend who was to observe another surgery. He is a design engineer at HSS, and had custom designed a knee implant for a patient that was to be operated on that morning. I was invited to observe this surgery, as it was a rare and interesting case.
Though total knee replacements are common, it is apparently not common for a patient to require a custom total knee implant. This patient was a young (34yrs) female who had been though some pretty bad accidents. At the age of 5, she was in a lawn mower accident, where her left hand was injured, resulting in the amputation of that arm from elbow downwards. Then recently, she was, again, involved in another lawn mowing accident where she fractured the anterior portion of her tibia (her tibial plateau), as well as her femur (midshaft). This required a plate to be implanted on her femur to stabilize the fracture and help it heal, as well as a couple of pins on her tibial plateau to hold the pieces together. But being so young (and thus quite active), also due to the severity of the injuries and her abnormal bone structure, she developed knee problems, which eventually to her being operated on for a total knee replacement with custom implants.
I was fortunate to be able to observe this surgery, but this case proved even more interesting. Two teams of surgeons were working on her for this replacement. The first team were a group of orthopaedic surgeons, performing the total knee revision. But working right next to them, on her torso, were a group of plastic surgeons from NYP-Weill, working on harvesting some muscle tissues from the left side of her ribcage. Apparently, the injuries to her femur and knee has ripped apart must of her muscles and other soft tissue, that required an autograft of muscle tissue to help pad and stabilize her knee. I had never seen a plastic surgery, so this proved to be a very exciting and education case. the muscle tissue required was so large, that the had to make a cut from right underneath her armpit down to about hip level, to get a piece long and large enough for the transplant. This was also a lesson in human anatomy for me, and even the orthopaedic surgeons were very impressed.

Other interesting bits and pieces from my week

From MRI reading with Dr. Potter
- Syndesmosis: an articulation in which adjacent bones are bound together by a ligament. The syndesmosis of the ankle is made up of anterior tibiofibular ligament, interosseous ligament, and posterior-fibular ligaments. Following trauma to the ankle, such as an ankle fracture, the syndesmotic joint can become unstable and painful. Surgery may be needed to stabilize the syndeosmotic joint to allow these ligaments to properly heal

- Ankylosis: Stiffness or fusion of bones in a joint. The rigidity may be complete or partial and may be due to inflammation of the tendinous or muscular structures outside the joint or of the tissues of the joint itself. When inflammation has caused the joint-ends of the bones to be fused together the ankylosis is termed osseous or complete. Excision of a completely ankylosed shoulder or elbow may restore free mobility and usefulness to the limb.

- Insufficiency fractures: a subgroup of stress fractures. It is caused by the effect of normal or physiologic stress upon weakened bone. Loss of bone trabeculae decreases the bone's elastic resistance. Sites frequently affected by insufficiency fractures are the thoracic vertebra, tibia, fibula, and calcaneus and they tend to occur more among older women. The most common cause of insufficiency fracture is postmenopausal osteoporosis. Other important causes are senile osteoporosis, pelvic irradiation, corticosteroid therapy, and rheumatoid arthritis.

- Osteolytic lesions: A "punched-out" area of severe bone loss. Are seen in metastatic lung and breast cancer and multiple myeloma and may cause bone pain, pathologic fractures (bones broken by disease), and hypercalcemia (high blood calcium)

- Particulate disease: Biological factors, which contribute to failure, involve local migration of wear debris from the articulating pair of the joint interface. The wear particles are believed to have the potential to form macrophages which in turn may stimulate osteoclastic activity of bone (bone resorbtion). This causes particulate disease which can lead to loosening of a prosthetic implant.

- Synovitis: inflammation of a synovial (joint-lining) membrane, usually painful, particularly on motion, and characterized by swelling, due to eff
usion (fluid collection) in a synovial sac (such as that present in the knee joint).

- Joint effusion: excessive fluid inside the joint. A joint filled with blood, rather than joint fluid, is usually called a haemarthrosis.


Blogger Weill Immersion Program said...

tunde, when will i see a surgery case with you? yi

6:32 AM  
Blogger Dr. A. M. Rajani said...

Orthopedic surgery or orthopedics (or orthopaedics) is the stream of medicine concerned with conditions and treatment involving the human musculoskeletal system.

4:46 AM  

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