Those of you not in the medical field might think that this
title refers to some crazy track workout or some ancient Spanish tradition. Actually,
it refers to a treatment team sitting down at the end of the day to quickly go
over each patient on the service and hitting the main points of their
treatment. I would like do this with you so that you all can get a flavor of
the kind of patients that we are seeing here. For the medical people, please
note that I will be skipping a fair number of details that you would probably
like to know on the patients. For the non-medical people, I will try to explain
the jargon and any abbreviations that I use, but I can’t do all of them or it
will get too long. Let’s get started
1.
Male, 6 years old. Acute osteomyelitis (bone
infection) of distal femur and proximal tibia with septic knee s/p (status post,
it means that he had the listed procedures) sequestrectomy (taking out dead,
infected bone), I&D (irrigation and debridement, washed out the infected
wound) x 10, and ex-fix placement (external fixator, screws and pins that are
used to fix the fracture outside the body). I&D every 48 hours until
infection is controlled
2.
M57 Bimalleolar ankle fracture with ipsilateral tibial
plateau fracture type V vs VI (very bad upper shin fracture) s/p knee
immobilizer. Surgery tomorrow.
3.
M30 left sided femoral neck and midshaft shaft factures,
T-type condylar fracture (his thigh bone is in 5 pieces). Right sided degloving
injury to heel and foot pad, loss of 6 cm by 15 cm, presented after 4 days with
simple closure leaving in gravel and dirt and foul smelling from outside
hospital. S/p I&D x2, and internal fixation of femur fractures
4.
50M, transverse acetabular fracture , S/P
traction pinning and plating. Nonweight bearing for 2 weeks.
5.
F35 Left open (type IIIb) distal segemental
tib/fib fracture with ipsilateral patellar fracture and ACL tear. S/P I&D
and posterior gutter splint. Repeat I&D tomorrow
6.
M13 Distal open type IIIa tib/fib fracture. S/P
I&D and splint. Ex-fix under C-arm (x-ray in the OR) today
7.
M32 Surgical neck and medial epicondyle closed fracture of humerus with 10 cm wound. S/P
I&D
8.
F16 Proximal 1/3 femoral shaft fracture, closed.
S/P traction pinning, Intramedullary nail (a metal rod that goes down the
middle of the bone and is held in place by screws at either end) tomorrow.
9.
M45 Left distal and right midshaft femur
fractures s/p bilateral traction pins, Colles wrist fracture s/p casting. Bilateral IM nail today
10.
M49 Closed bimalleolar ankle fracture, s/p
casting. Open reduction internal fixation later this week.
11.
F18 Distal 1/3 open tib/fib fracture. S/p multiple I&D’s, Ex Fix and skin grafting
12.
F30 Med malleolus facture s/p casting, 3x10 cm
skin loss s/p skin grafting.
13.
F50 degloving injury (skin is ripped off) to
ankle and heel 20x30 cm, open tib/fib type IIIB. S/p ex fix and I&D x4,
possible amputation vs contralateral leg skin flap.
14.
F70 severe bilateral hip osteoarthritis with
less than 20 degrees of movement in any direction. S/p bilateral girdlestones
(removal of head of the femur)
15.
F45 remote history of AK47 wound to
subtrochanteric femur with segemental bone loss. Was treated with IM nail and
cement spacer placement at Soddo, lost to follow up due to funds. Presents with
draining wound and proximal screw from IM nail (yes, it came through the skin).
S/p bead placement, plan to remove next week and exchange IM nail
16.
F25 6 weeks out from flexion-distraction injury
to C5/6 s/p closed reduction with continued unilateral slipped facets. S/p
spinous process wires, iliac bone grafting and facet wires for fusion of C5/6
17.
M35 Night stick fracture of ulna with severely comminuted
distal tib/fib fracture. Ex-fix tomorrow.
18.
M8 chronic osteomyelitis of tibial s/p I&D
and sequestectomy x5 with segmental bone loss. Will bone transport once
infection is cleared
19.
M30 Tibial plateau fracture schattzer type IV.
S/p posterior gutter splint. Ex fix today
20.
M13 chronic osteomyelitis of tibial s/p I&D
and sequestectomy x2 with segmental bone loss. Traction pin in place. Will bone
transport once infection is cleared.
21.
M24 Chronic osteomyelitis of radius. S/p I&D
x 3 and sequestrectomy Progressive wound closure.
22.
M10 Chronic osteomyelitis of tibia. S/p multiple
I&D ‘s sequestrectomy, epiphysiodesis (removal of growth plate to prevent
limb length discrepancy) and casting.
23.
M15 Chronic
osteomyelitis of tibia. S/p multiple I&D and sequestrectomy and ex fix. Will bone transport
24.
M30 Open tib/fib type IIIb, s/p lateral
rotational flap, ex fix and 3x8 cm skin graft. Middle humerus fracture, s/p
casting.
25.
M60 Open tib/fib type IIIb, s/p lateral
rotational flap, ex fix and 3x8 cm skin graft.
26.
M25 Proximal segemental tib/fib, s/p IM nail.
Discharge today
27.
F22 extreme valgus deformity of tibia. S/p
corrective osteotomy
28.
M32 Pathologic femoral neck fracture ( PMHx polio).
s/p girdlestone, complicated by post op wound infection, I&D x2
29.
M25 patellar fracture s/p wiring and extension
casting for 3 months (this basically fused his knee straight). Hardware removal
and lysis of adhesions today
30.
M35 chronic elbow dislocation, waiting for
surgery
31.
M6 Acute osteomyelitis of tibia and septic knee.
Multiple I&D with gradual wound closure.
32.
M15 Chronic osteomyelitis s/p ex fix,
sequestrectomy and multiple I&Ds. Currently transporting bone.
33.
M30 Chronic hip dislocation s/p open reduction
with corrective osteotomy and IM nail
34.
M55 chronic shoulder dislocation, waiting for
surgery this week
35.
M10 Pubic rami fracture, s/p traction pinning.
Degloving injury to pelvis 8x12 cm, s/p full thickness skin grafting
36.
M35 acute posterior hip dislocation s/p
reduction. Open type IIIa middle 1/3 tib/fib fracture s/p ex fix with IM nail
soon. Tibial plateau fracture type V.
37.
M30 Previous proximal tib/fib fracture with IM
nailing and middle 1/3 femoral shaft fracture with IM nail. Presents with
femoral neck fracture. Girdlestone tomorrow.
38.
M45 Open IIIa distal tib/fib fracture s/p ex fix
with wound vacuum, will discharge today.
39.
F75 Distal femur and femoral neck fracture. S/p
gamma nail (basically an IM nail with a big screw that attaches to the end and
holds the head of the femur in place)
40.
F25 Open humerus IIIb fracture15 cm of segmental
bone loss. 3x20 cm of skin loss. Complicated by cellulitis and abscess
formation. S/p multiple I&Ds
41.
M6 acute osteomyelitis of proximal tibia with
septic arthritis. S/p multiple I/D
42.
M10 chornic osteomyelitis of tibia. S/p multiple
I&D’s, rotational skin flap and skin graft replacement.
43.
M10 L open type IIIb tib/fib fracture. S/p ex
fix, medial rotational flap and skin graft
44.
M30 Acute traumatic big toe amputation with 10
x10 cm degloving injury to dorsum of foot. S/p I&D x 3 and skin grafting
45.
M30 chronic mid shaft humeral fracture with
nonunion (He broke his arm a long time ago and the bone never healed so he
basically had two elbow joints) s/p plating
46.
M 25 open type IIIa middle 1/3 tib/fib fracture
s/p ex fix and I&D
47.
M22 open type IIIc (femoral artery injury)
distal femur fracture. S/p I&D x6, antibiotic bead placement, IM nailing
48.
M70 Closed comminuted intertrochanteric hip
fracture. S/p dynamic hip screw
49.
M35 Open type IIIa tib/fib s/p IM nailing.
Complicated by poor alignment after fixation requiring return trip to OR to fix
external rotation.
50.
M16 open type IIIa distal tib/fib and Achilles tendon
rupture. S/p Im nail and rush rod of fibula
51.
F50 closed middle 1/3 spiral femoral shaft
fracture (fracture site ~15 cm) s/p tibial traction pin. Will IM nail soon.
Diagnosed with type II diabetes on presentation with sugars in the 400s
52.
F26 closed bimalleolar ankle fracture. S/p
posterior gutter. Waiting for decreased swelling before surgery.
53.
M7 closed distal tib/fib fracture s/p lower leg
casting. Degloving injury 3x4 cm s/p grafting
54.
M 25 closed midshaft femur fracture. S/p IM
nail.
To those of you who stuck out to the end, I salute you and I
hope that you found this mildly interesting.
In Him,
David
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