Annals of the Orthopaedic Theatre at KCMC

My cases this week have included the following:

A club foot repair in a young boy who was walking on the top of his foot because of the deformity of the foot and ankle.

Kuntschner nailing of a femur fracture that happened 3.5 months ago. Kuntschner nails were manufactured decades ago but are still frequently used here.

Retrograde (from the knee) nailing of a femur fracture that happened three months ago. I was told at morning report that both femur fractures were acute and didn’t find out the chronic nature until we arrived in theatre. Basically it made it much harder. Both cases went well however.

An arthroscopy on the knee of a patient involved in a motor vehicle accident. This was the fourth arthroscopy done at KCMC with many people coming into the OT to see what the “Muzungu” was up to.



Debridement of an open fracture of the femur in a patient who fell at high speed off a motorcycle. His femur was sticking out of his leg and I found clothing and road debris inside the center of his femur. He also has a tibia fracture involving the same leg.

Irrigation and debridement of a child with acute osteomyelitis of the femur (infection of the thigh and femur). We drained about a liter of pus (sorry for mentioning this).

Removal of an accessory thumb and realignment of an extra toe on a small child with polydactyly.

Excision of a radial head in a man with no forearm rotation due to a malunited and arthritic radial head (part of the elbow joint). The xrays were not available, so I was operating on a patient I had not met until the theatre and based upon a brief note in his chart.

Sequestrectomy of the femur in a child with chronic osteomyelitis. Basically this is removing the dead portion of bone on the interior of the femur that happens with chronic infection of the bone.

Open reduction and internal fixation of the radius and ulna in a boy with a forearm fracture. Once again I was assured that we had all the equipment. I even picked out the plates I would use but when it came time, the plates had been lost. Then we found the plates but not the right screws. Then we found the screws but not the screwdrivers. We improvised and everything turned out fine.

The conditions are very challenging but I really like the people in theatre and we know each other well enough to joke around and have a good time. We have a number of medical students observing both from Tanzania as well as from England, Scotland, and Ireland. I really have enjoyed teaching the students, the assistant medical officers and the residents. That aspect has been very, very rewarding. I have become good friends with a nurse anesthetist who is also a nun. She worked in the Sudan prior to coming to KCMC and has some amazing stories to tell about working in a war zone.

We will be gone for a few more days, to Ngoro Ngoro Crater and Serengeti National Park, tent camping on safari. We will post on Monday or Tuesday of next week. Cheers.