There were 3 cases on the operating list today: non union forearm fracture, fracture radius and ulna 4 weeks old and a femoral nailing. The morning started with a below knee amputation which wasn’t on the list but was a patient of the local orthopaedic surgeon who obviously manages to get his cases done whenever he wants! The next case was a non union of the radius and ulna with a broken radial plate and a previously removed ulnar plate for sepsis. The angulation of the forearm was gross and we carried out a replating and bone grafting from the iliac crest. The next case was the forearm fracture and I showed the senior resident how to do an open nailing using old fashioned Rush nails. The residents thought it was a good technique and I am sure they will use it many more times considering the mountains of Rush nails I have seen in the famous ‘Alibaba’s Cave’ which is the cupboard in theatre where all the orthopaedic implants are kept.
The last case was cancelled because theatre staff had run out of steam!
I popped over to the outpatient clinic to see a few patients. An adolescent boy whom I saw at the beginning of the week with a history of osteomyelitis of the humerus and multiple surgical operations in the past came back with a pointing abscess over the lateral aspect of the distal arm and Xrays showing a cavity in the distal humerus with periosteal new bone formation consistent with a Brodie’s abscess. He will require to have that drained tomorrow and the bone curetted out. Then I saw a 10 year old girl with bilateral genu valgum, short stature and a swollen abdomen consistent with Kwashiorkor (malnutrition). Her father was saying that she wasn’t eating very well and that he had a lot of other kids which probably means that he can’t feed his children properly. I asked the resident to get some blood tests, an Xray of her knees( to exclude rickets) and a paediatric consultation. We shall see what the investigations will show!
That was the end of the day and when I got home Robyn had bought a great big tin of yummy Belgian chocolate biscuits. What a great way to finish another great day in Haiti.
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