The surgery I was watching was getting into the tedious stages, fitting and re-fitting a bone chunk that cracked off when the elderly woman had slipped on a banana peel (yes, you read that right). They already had an assist, so I wasn't scrubbed in for this one. Just as I was looking for a new distraction the orthopedic surgeon's pager went off. Once the bone was broken, we were able to tug it into position, and put a cast on while still applying traction with our hands, just long enough for the cast to harden. By then, the patient was just starting to wake up from the sedation. And while the patient didn't remember a thing - thank goodness - I definitely won't forget doing this for the first time.
A five-year-old boy had fallen out of a tree, and landed on his arm, which was broken. The emerg doc was going to re-set the bone, but wanted the orthopedic surgeon to have a quick look at the x-ray first. They called it up on the computer screens in the OR, and the surgeon gave his blessing that the emerg doc could set the bone himself.
I asked the surgeon if I could go watch the reduction of the bone, and soon was on my way to the ER where I found the doctor. I knew him from working with him in the ER a few weeks prior.
"I heard you're doing a closed reduction - can I watch?" I asked.
"No," he replied.
I was a little surprised, but didn't have time to react before he said, "You're going to do it."
"Uh, I'll give it a shot, but just so you know, I haven't done one before," I admitted.
"That's fine, I hurt my wrist. Come look at the x-ray."
That's when things got exciting.
This wasn't just going to be a regular reduction.
The doc showed me on the x-ray where the wrist had broken through the smaller of the two arm bones, the ulna - but not quite all the way through the radius.
Turns out that for a break like this to heal correctly, rather than just pulling the bone into place, like is done with most reductions, it was important to make sure that the break went all the way through the radius.
And how would that happen?
You guessed it... breaking the radius would be my job.
Sure enough, after a quick briefing, under close supervision, and as soon as the child was COMPLETELY sedated (what, you thought we would do this with the poor kid awake?!), it was time to hold on to the arm just above the wrist, and see-saw it back and forth at 90 degrees until I heard a pop and crunch. And that moment was just as the doc had predicted: "That's when all the eyes of nurses and staff watching will bug out of their heads." Fortunately, the child's parents weren't there to see what was involved.
Once the bone was broken, we were able to tug it into position, and put a cast on while still applying traction with our hands, just long enough for the cast to harden. By then, the patient was just starting to wake up from the sedation.
And while the patient didn't remember a thing - thank goodness - I definitely won't forget doing this for the first time.