The guy with three knees

I'm sure you think it's not possible to have 2 legs and 3 knees, but let me assure you: it is.

This guy comes to us with a 2-year old tib-fib fracture, not consolidated, and he's walking. He literally had an extra joint on one leg, the ends of the bone had somehow calcified and settled like a joint. It was incredible. (See pictures!!)

We could really make a difference in this guy's life. We could give him 2 straight legs and remove the 3rd knee!! 

So after spending a lot of time removing a lot of scar tissue and calcifications, we were finally able to put the two ends of the bone together, and Dr. Scott put an intra medullar rod for the Sign-nail repair.

It was a looong surgery, and there was a lot of pulling, pushing, hammering, etc. Bones are really freaking solid stuff!! It's not easy to break off the calcifications on the wrong parts. Again, Ortho is not my thing, but the fact that we could really reshape his leg was fascinating.

I'll stop talking and let the pictures tell the story. :)

Look at that articulation!

It was not easy to bring the ends of the bone together and straighten it

So much metal to choose from!! 

That's the intramedullary rod 

(Sign nail) going in

You can kinda see the rod 

going through

X-ray before operation

Sucess!!

A lot of my non-medical friends are complaining about the graphic nature of my pictures... so for today I have a different kind of post: 

Meet Ali- a kid of about 16:

He came to us several weeks ago with a femur fracture. He was in traction for a bit, then Dr. Scott did a perfect sign-nail repair. 

Ali speaks only arabic, and only understands a few words of French. The first time I met him, it was to start him on physical therapy after the surgery. His cousin was translating for me, and when I said we were going to do some exercises, his answer was a cathegoric "no way!" 

He clearly didn't know me very well... 

Of course, I didn't take no for an answer, and over the course of another couple of weeks, we exercised every day, and improved the range of motion of his knee, which at first was only about 30 degrees. 

He did NOT get infected, his wound healed nicely, and he was discharged. 

Today he came for his weekly check-up, still using crutches. 

That's his current range of motion. He's pretty good at exercising on his own, and I have no doubt he will continue doing it and regain the few degrees still missing...

So today, I had the pleasure of pronouncing him completely healthy and telling him he had no need to come back to the hospital, or to use his crutches again. 

I admit, it was weird actually saying to him "get up and walk!" 

But he did. A little wobbly at first, but gaining confidence with each stride. 

SUCCESS EXISTS!!! And it tastes good! 

:) 

Fractures

The most wide spread form of locomotion here is the motorbike. You're either walking and trying not to get hit by a motorbike, or you're on a bike trying to avoid the people and goats everywhere. There are some cars, but they are by far the minority. 

People also like to climb trees to get fruit. And they also seem to fall off trees and break limbs, quite frequently. 

The result of those two facts, is a steady stream of fractures that trickle into the hospital every day. 

They're also not simple fractures, set, cast, go. No sir! They're compound, spiral fractures, some open fractures, most old and already infected. Today someone came and asked me if there was anything we could do about his limping. I asked him when did it start and he said 8 years ago, after he had broken his leg. Clearly it healed wrong, and 8 years later, there's absolutely nothing we can do about it... 

The other day I mentioned I got to scrub in on a patela fracture reconstruction. This was a big, strong man, and he actually fell off a moving bus with his knee into the asphalt. It broke his patela in 3 places and kinda looked like a jigsaw puzzle, trying to put the pieces together. 

Then I also got to see a sign-nail intra-medular tibia repair, and that was incredible! 

I never thought ortho would be so interesting, but we really get lots of broken bones here. 

Anyway, the last few days have been a blur of surgeries and patients, also doing mobilization and getting patients out of bed and walking. 

Sorry if this was a somewhat boring post, but I have to get some rest... After 10 days, it seems my stomach finally lost the fight and I've been on rehydration solution and toast all day. Oh well... part of life, I guess! 

(I got tested, it is NOT malaria! Woohoo!!!)