Today was a tough one, long day, starting with a tense meeting. Blaming, half truths, not much progress. Patient care is always the way forward, though. Dr. Higgins tackled some tough cases in Room 8, I worked with some residents in theatre 6. Our first patient was a guy who had a terrible elbow fracture, a pedestrian who was hit by a car. His elbow was shattered, and had protruded out through the skin. He had had a surgery a few days ago to clean things out, so was ready to have his fractures fixed.
These are really tough fractures, and I enjoy fixing them. It’s gratifying to take a “bag of bones”, as it’s called, and end up with something that works like an elbow joint. It took about three hours, but the pieces came together pretty well, and I’m hopeful he’ll have a good recovery.
Next was a very unfortunate 11 year old boy, who had suffered from tuberculosis (TB) of the ankle. The TB had healed with treatment, but his ankle joint was destroyed. This left his foot fixed in an awkward position, like a ballerina standing on her toes. Furthermore, the involved leg had been so damaged by the infection that it was about four inches shorter than the opposite leg. This left him with a bizarre and painful gait.
Dr. Higgins emailed his pictures and data to a paediatric limb deformity correction specialist back in Salt Lake City, Utah. The doctor there put the young boys measurements through a software they use for deformity correction! He emailed us back the specifications for the surgery, and we did that today.
First step was to correct the deformity. I took a wedge shaped piece out of the front of the fused ankle, which allowed us to move the ankle back into the proper position. This was then fixed with a special angled device Dr. Higgins had brought with him from Utah. This worked beautifully, and we sewed him up. Now time to address the limb length deformity.
The doctor in Utah had calculated that if we stopped the function of the growth plates of the opposite leg at both ends of the tibia (shin bone), then as he grows, the previously infected leg would catch up in length with the well leg just as his skeleton stopped growing at about age 18. We made four tiny incisions, one on either side of the knee and one on either side of the ankle. We drilled and placed some robust screws across the growth plates, immediately stopping the lengthening of that shin bone. He’ll have very little pain on this side, and can start walking with crutches immediately.
He’ll be in a cast for about six weeks, and can then start walking on his new ankle. The exciting part of this case, is that it involved equipment and expertise imported by Dr. Higgins from Utah, but was accomplished by Kijabe Hospital.
Pretty tired and going to call it a day.