Thursday, 10 May 2012

week 1 , days 2-3

so it's been a busy few days.  i spent tuesday and wednesday in the OR as it's called here.  one of the residents reckons the orthopaedic theatres are probably the newest in the world.  they were opened last year.  they are fancy, i'll give them that.  they contain four massive lcd screens which are connected to the pcs and you can see the patient's trend in vitals during the op, what time they got into theatre, what time the op started in addition to displaying i.i. (image intensifier) films on them and the CT or Xray of the initial injury.  They're quite quiet it's rare that anyone plays music, but the atmosphere is jolly and quite relaxed.  The scrub sink is located outside the theatre (which I find odd) and the patients are induced in theatre- there is no such thing as an anaesthetic room here... very bizarre.  Considering that anaesthetists can get super protective over who can and cannot enter their little room whereas here they don't care too much, it's quite a contrast.  And I don't htink I've seen an anaesthesiologist actually put someone under yet.  Seems like the OPD equivalent does it all here!! I can see why PAs at home get put out because all they do is ward work, allied health professions are given much more responsibility and autonomy here compared to at home.
So approaches and techniques are relatively similar, although I did see a patellar fixation that varied substantially from the way it's done in the UK.  Apparently most will hold it together using screws but here they thread through wire via the cannulated screws to hold it together.  My attending said he'd been taught that here.  So clearly that's unique.  When it comes to total hip replacements, the trend here is not to cement the acetabular component which is very unique.  It's just not the done thing.  The residents don't feel comfortable doing it either, (I suppose because they haven't ever done it).  I find these trends fascinating.  Who decides that one day, they're just going to stop cementing in that bit because they don't like it.  And somehow it catches on...  Is that the American culture?  There's not really an evidence base for it, because unlike the UK, they don't have a joint registry so they can't keep track of it over a long period.  I guess they'll look back using retrospective studies.. but that doesn't really help the patient's of today.  One thing I'd like to talk about more is their views on resurfacing.  Considering that it's got such a bad press at home, I'd like to see it that has extended over the Atlantic.  Admittedly, it's not their area of expertise but it's interesting to see what their views are. 
OR cases: Patella fixation, I&D, Right hemi, I&D of right iliopsoas abscess
Both bone (lol, radius and ulnar) fixation with plates, volar locking plate for left distal radius, ex fix for pelvic fracture, ankle ORIF, tibial plateau fracture
Clinic cases: tibial plateau , tibial pilon fracture, pelvic fracture, HO case, subtalar ankle fusion

Back to the OR tomorrow.  Initial observations on the American system vs the UK system come the weekend.

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