Orthopedics.

I spent yesterday shadowing a PA in the orthopedics department. It was a long clinic day, but I found the cases to be moderately interesting - certainly more so than last week's family practice marathon. Also, I was happy to be back at my home hospital, so I'm sure that helped me get through the drudgery of the 26 patients we saw over the course of the day.

We saw several cases of rotator cuff tendonitis/tears. Most of the patients were being treated with a combination of exercise and steroid injections, and only one of the five or six patients was feeling enough pain to opt for arthroscopic surgery. D., the PA, informed each patient that their recovery would likely take months, but that 90% of patients would heal on on their own, and of the 10% that require surgery, over 94% have good surgical outcomes.

Given the nature of the practice, we also saw a slew of broken bones, mostly in kids (the youngest being a 2-year old girl with a broken tibia following a car accident). Looking at the before and after xrays for each of these patients, I found I could find identify the fractures pretty easily, and even notice old, healed fracture sites. The worst case was a 13-year old male skateboarder who had three fractures in his ankle, including one that split the growth plate into three pie-like slices, or so they appeared on the CT. The kid was, to be blunt, fat and a bit repulsive, and D. told him that he would probably have many more injuries if he continued skateboarding. His mother didn't seem too unhappy with that news. In fact, she was more interested in snapping pictures of the kid's CT scans to share with her friends. The kid was clearly afraid of the fact that he needed surgery to reset the bones, but his mother was obviously clueless and couldn't offer any words of reassurance. Of course, 13-year old boys are universal idiots, and I couldn't exactly blame her for not showing much sympathy. I certainly wasn't going to step up and say anything; I try not to interfere when I sense weird family dynamics.

The most interesting case was a 49-year old male who presented with an acute ruptured Achilles tendon. D. allowed me to feel the patient's good, unbroken left tendon and compare it to the right one. The point of rupture was easily identified because there was an obvious, palpable dent in the tendon (not to mention that the guy's entire lower leg and foot were swollen and bruised). I left for the day after D. told the patient that he would need surgery to sew the tendon back together, and I assume that the procedure was either performed that evening or will be performed sometime within the next 48 hours.

Anyway, for the most part I enjoyed the day, and would like to spend some time in the OR to watch some orthopedic procedures.