Everything has been quiet since our last blog. We actually had a few cooler days in the 110's. There is a phenomenon that I had never experienced though related to heat. We take showers in a metal box. It looks like those containers that you see unloaded on ships or traveling around on trains with supplies in them. They convert them to showers and restrooms. This may be a little too familiar but I just thought it was weird. We have hot water here so that's great. The shower box has air conditioning in it sometimes. It doesn't work all the time. Lots of times I work out in the afternoon come back and shower up for the day. The past week with ac not working in the shower it is pretty hot especially when we are hovering around 125 in the mid afternoon. The phenomenon is when you take a shower the hot water actually feels cooler then the air in which you are standing in. Kind of funny, huh. It actually feels like a relief. I just hate cold showers but the cool water is b/c it can't be any hotter then what your living in. Getting accustomed to it though.


Today's story is about a surgery that we did this week. Orthopaedics is a passion of mine. I love to fix people. Even here where I have suspect of the conditions I have felt like we needed to take care of things. What has happened is the word gets out and we do more cases then usual and it feels pretty good to put some education to work. Today i want to share with you a case of mine that we did this week. Most people know about doing arthroscopic work on knees and shoulders. Replacing knees and hips and doing trauma orthopaedic surgeries like hip fractures and wrist fractures. There are a whole set up problems out there that show there ugly head that nobody hears about as often or even treats.


Orthopaedics has been what I have wanted to do since about the age of 19. We have covered this but when you go through medical school your not sure your grades or board scores are good enough. I got fortunate to end up at a great program in Richmond, VA where they put you in the fire from day one. When things get tough and you work hard and you stay with it the surgeries and problems get easier to fix. We talked about the 10,000 hour rule. The closer you get in practicing your profession 10,000 hours in your lifetime the greater your expertise. Practice makes perfect. With orthopaedics it is perfect practice makes perfect outcomes. We have to strive for that. I treat almost everything but don't due back surgery and specialized pediatric surgery. One of the main reasons I came home besides taking care of the people from here is allowed me to practice the whole spectrum of orthopaedics. I feel like it is always challenging and rewarding. You always are doing different things. There a lot of surgeries that are the same but everyday is different. I really would not like just doing shoulder arthroscopies and not work on knees, or due back surgery and that's it. The other fun part is to continually challenge yourself with education and learning new techniques that make outcomes better. I have been criticized for not performing time tested proven inexpensive measures. The goal is the best outcome. What would give you that. Well if we did the same stuff we did 10 years ago we would not have evolved a ton of new techniques and better outcomes. If you look at data and research then you see outcomes are improving with the techniques that we have learned over the last 8-10 years. We still fix ankle fractures the same but now we put more plates and screws on wrist fractures. Proven to be better outcomes. So what is better? Being stuck and not caring about being a better surgeon, or doing the right thing and making yourself a better surgeon so people have better outcomes. This next year I going to get a new partner by the name of Travis Stoner. I am really excited b/c when new guys come out there are certain things they can teach you. He is spending a year at the Cleveland Clinic in total joint reconstruction. I guess he is going to learn the time tested proven methods. Not really. I am excited for his new knowledge base. Our goal in the next year at our clinic is to move towards performing anterior hip replacements. The outcomes are now showing earlier recovery and great results. Dr. Stoner will be an important role to move forward in this process. I always looking for a challenge and am excited about our future.


Background on this weeks case. I will show you pictures so don't get sick and throw up on your computer screen. Look away. I promise you it won't be a picture of my ugly beak of a nose. Operating room pictures. The young man we are treating is in his 20's and is from Iowa. We all know what that stands for. He is an enlisted soldier and he gave me specific permission to talk about his case. We won't even come close to using his name. His job her is really interesting. He actually is a part of a group that does intel. Fancy name for spying and information gathering. Had some talks about that which is pretty cool but pretty dangerous. Anyway he presented with pain in his lower arm. About 3-4 inches above his elbow on the inside. No trauma. Getting worse over the year. It has gotten so bad that it makes his hand go numb and fingers turn funny colors when he does anything strenuous. It is progressively getting worse. Now it is waking him up at night. Here is an xray.




What you are seeing is a picture of his arm, specifically the humerus and the bottom half. If you look closely you will see a hook of bone coming off of his real bone towards the front part of his body. This is a spur of bone that he has had his whole life and now it is giving him trouble. The question why after all this time. Not exactly sure now expect he has to do a consistent amount of work everyday. He has to wear those kevlar vest and carry a gone and I think it stirred the whole thing up. I told you his symptoms but what caused this.


Well this is the cool part of orthopaedics. i have just came to Iraq to find this guy with a problem that I probably see never again. I have though helped operate on this problem before while in residency. What this is, is a ligament that all of us has in our arm. It specifically is called the Ligament of Struthers. I have no idea who Struthers is. So don't ask. This ligament has ossified for approximately 2 centimeters instead of straying a flexible ligament. Well this hook is rubbing right over the top of the major artery and nerve to your forearm/hand. This is causing his symptoms. So what do we do?


This is where I paused in my next step of treatment which is obviously surgery. The thing that made me pause was the environment and equipment. Not as perfectly stocked here to due everything but basic stuff. Still no drill for one instance. He then convinced me. This is why. He goes home and leaves his unit high and dry with one guy short. Somewhat of an elective surgery b/c it could wait but he still has 6 months to go. Together we decided to get this taken care of here so he can continue to help due his job while he recovers. He was pretty brave about it. Pretty cool guy. The other concern is the exposure for this area with a significant arterial, venous, and nerve highway rolling right under and over that thing. The was solved by my general surgery buddy Dr. Braswell. Therefore we decided to do it as a team and fix this problem.


Here Braswell and I have scrubbed in to proceed with the surgery.




He will expose the neurovascular bundle and I will CHOMP that big hook of bone off. YIPPEE. True orthopaedic excitement when it comes to surgery. This is an image of the exposure.




The whole went great put this thing was stuck right to the artery. The ligament was cut at the end of the bony prominence and was let go. This ligament provides no structure importance to the elbow. i believe if I am right it is a developmental process when we are young and he just created more bone then almost everybody else. I then chomped the end off. Here it is.



It look small but felt big plus that was about half of it. The rest I carefully chomped away at it with small pliers like device called a ronguer. Smoothed it off perfect. No problems. We then closed him up real good.



Say that with a southern accent like Dr. Braswell. it sounds funny.


He did well after surgery and went home the next day. I will keep you up to date.


I hope that everyone is dong well. Remember the haircut contest for the basketball youth teams. I hope we can do some good and have some fun. If you have questions on where to send anything or whatever call the clinic at 402-462-2139. Thanks


Play Hard
Play Smart
Play Together