a day in the OR

This week, I spent about 10 hours shadowing one of the amazing doctors from MUSC.  He is an orthopedic oncologist, which is a very unique and rare specialty.  Dr. L specializes in bone tumors, but he works on general orthopedic cases as well.  I chose to shadow him in order to get more experience in another interesting focus of surgery: orthopedics!

I spent 2 hours in the clinic with him and his team on Monday, learning about how they deal with patients and what type of cases they work.  Then, I showed up at the hospital at 6 am on Wednesday to attend the Orthopedics M&M (Morbidity and Mortality) conference, which is where the residents discuss with their attending physicians things that went wrong in various cases and what to do differently next time.  After that, we headed to the OR! I got to observe two surgeries, which took about 6 hours total.

Here are two videos from youtube (preceded by explanation of what the surgery entails) showing surgeries similar to what I observed:

(ps I know a lot of people will find these too graphic, but for those who aren't squeamish about surgeries, these surgeries are super cool!)

1.  Total Hip Replacement (this video is of an anterior approach, and we did a posterior approach...but same idea!)

• Cut through the skin, fascia, fat, and muscles to get down to the joint capsule, which is opened.
• Dislocate the hip and remove the head of the femur (which is the problem...often, it is arthritic)
• Ream (with a thing that looks like a circular cheese grater) into the acetabulum (aka the hip bone, where it articulates with the femur) until you hit bleeding bone (which will help the bone grow into the implant)
• Place an acetabulum prosthetic and plastic liner
• Ream (aka drill) into the femur with increasingly large reamers and then fit the hole in the bone with the correctly sized broach (which is a piece of metal that is the same shape as the prosthetic)
• Place the prosthetic into the femur (this part is called the "stem")
• Then add a false neck and the real femur head prosthetic
• Relocate the hip and take an X-ray to check leg length (want it the same as the other leg!)
• Dislocate the hip, attach the real neck and femur head prosthetics to the prosthetic stem
• Relocate the hip
• Sew the patient up!

2.  Tibial Nail

• Make incisions over the knee, to the side of the knee (slightly lower than other incision), and to the side of the ankle
• Disarticulate the tibia from the femur (aka pop your lower leg bone out of the knee)
• Place a guide pin to make sure you are going through the center of the bone as you ream down (as was done in the hip replacement)
• Hammer nail into place
• Screw nails at side of knee and side of ankle incisions (to ensure stability)
• Place tibia back in place
• Sew the patient up!

TOO COOL!  These surgeries make such a difference in the patients' lives...decreasing pain, increasing mobility and quality of life! Amazing.