I feel like an idiot. What was I thinking! Of course, the wound would get infected. I was too optimistic when I wrote that the wound looked great three days later and maybe a miracle would happen. The fracture got infected the next day. I tried to clean it out again and cover the bone with some muscle. That got infected. I tried to cast it in various ways, the bone didn't stay in place and kept pushing out through the wound, seeking the outside air like a drowning man. Nothing seemed to work. I thought maybe we'd have to amputate. Finally, we just left the whole thing open and let diluted bleach dressings do their trick. Slowly the wound cleaned up and granulation tissue formed. We kept asking if anyone could send us an external fixator, no one could find one. Finally, the wound was clean but the fracture was still only partially stabilized and the bone was still exposed.
Luckily, I am temporarily not alone. Dr. Bond and Dr. Jason Shives are with me in Bere. We talk about the open tibia fracture and what to do. Finally, we come up with a brilliant plan straight out of the MacGyver archives. Abel and Simeon prepare the patient while I head over to the house. I find a long piece of two and a half inch pipe that seems pretty strong. I grab a saw from the tool box and we cut two pieces off, roughly the length of a certain man's tibia.
Meanwhile, Jason and Abel have brought out the small generator and the cast saw and have been spewing plaster powder all over the ward in an attempt to take of the full leg cast.
We rejoin Bond in the OR where we try out Bond's regional spinal anesthetic technique by having our patient lie on his left side, the side of the fracture, while we put in the spinal lidocaine and let him sit on that side so only his left leg will be numb. When it's settled in, we turn him back onto his back and I hand the leg off to Gabriel to hold while Abel preps the leg with Betadine.
Jason and I scrub while Bond directs and advises. I first pull out some pieces of infected sequestrum and chip off some of the bone sticking too far out with a rongeur. We twist the leg into a more anatomical position and Gabriel holds it steady. I follow Bond's suggestion and make four tiny incisions, two above the wound and two below. Then I take a regular, unsterile cordless drill with my right hand and insert a sterile, threaded Steinman pin into the drill with my still clean left hand. I insert the still sterile end of the pin in one of the incisions and push it against the bone. I then squeeze the trigger and thread the pin in and through the tibia till it pokes the skin on the other side. Jason makes a small cut with the scalpel over the pin and I drill it the rest of the way through till it's sticking out the same amount on both sides. I repeat the processes for the remaining three pins.
Then, while Jason holds the PVC pipe steady against the pins, I mark where they should go through and then drill holes through the pipe. I then force the pipe over the pins till the pins hit the other side of the pipe. I then try to estimate where I should drill the second holes and mark the pipe again. I drill again and this time get each pin to go through it's second hole with the help of a little hammering. I repeat the process on the other side.
Gabriel lets go his stabilizing hold on the leg and we confirm that the fracture is now stabilized. Jason wraps gauze with Betadine around the pins while I dress the fracture wound with diluted bleach and we take him back out to the ward. It's once again in God's hands.
Luckily, I am temporarily not alone. Dr. Bond and Dr. Jason Shives are with me in Bere. We talk about the open tibia fracture and what to do. Finally, we come up with a brilliant plan straight out of the MacGyver archives. Abel and Simeon prepare the patient while I head over to the house. I find a long piece of two and a half inch pipe that seems pretty strong. I grab a saw from the tool box and we cut two pieces off, roughly the length of a certain man's tibia.
Meanwhile, Jason and Abel have brought out the small generator and the cast saw and have been spewing plaster powder all over the ward in an attempt to take of the full leg cast.
We rejoin Bond in the OR where we try out Bond's regional spinal anesthetic technique by having our patient lie on his left side, the side of the fracture, while we put in the spinal lidocaine and let him sit on that side so only his left leg will be numb. When it's settled in, we turn him back onto his back and I hand the leg off to Gabriel to hold while Abel preps the leg with Betadine.
Jason and I scrub while Bond directs and advises. I first pull out some pieces of infected sequestrum and chip off some of the bone sticking too far out with a rongeur. We twist the leg into a more anatomical position and Gabriel holds it steady. I follow Bond's suggestion and make four tiny incisions, two above the wound and two below. Then I take a regular, unsterile cordless drill with my right hand and insert a sterile, threaded Steinman pin into the drill with my still clean left hand. I insert the still sterile end of the pin in one of the incisions and push it against the bone. I then squeeze the trigger and thread the pin in and through the tibia till it pokes the skin on the other side. Jason makes a small cut with the scalpel over the pin and I drill it the rest of the way through till it's sticking out the same amount on both sides. I repeat the processes for the remaining three pins.
Then, while Jason holds the PVC pipe steady against the pins, I mark where they should go through and then drill holes through the pipe. I then force the pipe over the pins till the pins hit the other side of the pipe. I then try to estimate where I should drill the second holes and mark the pipe again. I drill again and this time get each pin to go through it's second hole with the help of a little hammering. I repeat the process on the other side.
Gabriel lets go his stabilizing hold on the leg and we confirm that the fracture is now stabilized. Jason wraps gauze with Betadine around the pins while I dress the fracture wound with diluted bleach and we take him back out to the ward. It's once again in God's hands.
MacGyver Surgery 1
MacGyver Surgery 2
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