Final week in the Orthopaedic Department

This week’s surgical cases have included (partial list):

Three arthroscopies. We have done more knee arthroscopy during my month here than previously ever done at KCMC. The equipment and setup is less than ideal but functional. We have been able to see well and perform the basic skills such as removing loose bodies and excising meniscal tears.

Debridement of an open femur fracture with significant infection. This was a second look irrigation and debridement and due to the appearance of the wound, I fashioned a string of bone cement beads impregnated with an antibiotic and placed this inside the femur and in the wound to try and control the sepsis.



A corrective osteotomy of a forearm fracture from over a year ago that healed with severe angulation. The only xrays that could be located were from 2009. I had to cut through the radius and ulna using a series of drill holes to rebreak the bones (because there’s no bone saw), then used a rod in the ulna to stabilize the forearm in its new straight position.

A partial hip replacement (Austin Moore) on a woman who broke her hip over a year ago. The fracture never healed and the leg had shortened a lot. She was a small woman and it was very challenging placing the prosthetic component inside the canal of her femur. The instruments used to make room for the component did not match the component but with patience and heavy use of a large mallet and a little luck we were able to complete the case. The other surgeons said that they were surprised to see so many of the hip structures (hip capsule, tendon attachments, sciatic nerve) during the surgical approach. They have had problems with postoperative hip dislocations during previous similar procedures and hopefully with understanding and seeing the anatomy better they will be able to repair the appropriate structures while closing the wound, and this problem can be avoided.

We have had a constant flow of visitors in the operating theatre including medical students from Malaysia, England, and Scotland; a physical therapist from London, and biomedical engineering students from the US. This is a picture of our friend Grace, from Malaysia, sitting with Thompson in the surgeon’s lounge.



I have also included a picture of Forrest holding up his lab report showing no malarial parasites. We are all sleeping better at night now that he is feeling better and the fevers have stopped – we had him tested just to be sure.