By: Dr. Slauterbeck November 29th, 2022
Emergency Room
Before they take a patient into the emergency room, they must prep the patient. They will do one more examination and slightly clean the wound. While in the ER, they will perform a more in-depth cleaning with a saline solution. Once in the ER, the leading surgeon must determine the action plan.
Different Types of Treatments
Dr. Slauterbeck showed us four main types of treatments; a rod, plate, cast, and an external fixator. For our patient's injury, it would be more practical, to begin with, an external fixator and then transfer to a rod. A cast would be unethical because it was an open bone fracture, meaning the bone is exposed. Which would cause difficulty in wrapping it. A plate might be considered a good idea, however, a plate provides a "home" for bacteria. Since this wound is open and already exposed to many different bacteria, having a plate that attracts even more bacteria would be a bad idea. Beginning with a rod would work, but Dr. Slauterbeck believes that using a rod would be inefficient because of the bacteria. Therefore, he decided to use an external fixator.
<- external fixator
^ rod
The use of an external fixator will manage large amounts of infection in the bone. This allows for the bone to heal properly while also applying traction and keeping the bone in place. Applying the external fixator can take anywhere from 10-45 minutes in the OR. The patient will wear the external fixator for about two weeks before going back to Dr. Slauterbeck for a rod. Once the patient has had the rod surgically placed into the bone, it will stay there for the rest of their life. The only instances in which a rod may be removed is if the patient is an extremely active person (skier, skydiver, etc.).
How to Describe a Fracture
One problem an OR surgeon may encounter is communication over the phone. For the surgeon to understand the severity of the fracture or break the night nurse will describe the injury with specific terms, for example, displaced/angulated, proximal and distal. When describing the tibia, they refer to the portion closest to the head as proximal and most proximate to the foot as distal. When referring to the displaced portion it will always be in percentage form (EX: 80%), while when referring to angulated it will be an angle measurement.
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