Dr. Orthochick: Hip dislocation

I was supposed to have a "research day" yesterday, which would have been really nice since Dr. Jewish emailed me to inform me that my whole "summary" section for my paper sucked and i had to redo it since it did not "emphasize the points of this paper or convince the orthopaedic surgeon that this paper is in any way useful or relevent." He also asked me if I wanted to help him with a project, which means I have 3 projects going and potentially 2 more starting soon. So yeah, a research day would have been nice and I would have actually used it to get research done, thankyouverymuch.

As luck would have it, I had to cover a Dr. Grandpa case. It looked like a cool case, it was a hip replacement but the lady had a really deformed hip socket so it was going to be done a special way. The advantage to this is that it's a cool case, the disadvantage is that I don't get to do much. but i like hip replacements so OK, I'm cool with the whole thing. The surgery went fine and I ordered a postoperative xray to be done in the recovery room because that's Dr. Grandpa's MO. By that point it was around 10:30AM so I figured I could stick around and wait for the xray results and the results of the patient's hemoglobin and then head out to get some research work done.

I got paged by the xray tech who said "I'm not sure, but the hip looks dislocated."

If you think a hip looks dislocated, it probably is. It's one of those radiographic findings that's pretty hard to screw up. I'm pretty sure if you showed the xray to a bunch of laymen standing in Times Square, they could probably identify a hip dislocation. So I pulled up the xray and not only was the hip dislocated, but the whole hip socket had been ripped away from the rest of the pelvis.

If your hip dislocates, you can just do a closed reduction. If your hip socket gets pulled out of your pelvis, that's a bigger issue. So I frantically called Dr. Grandpa to tell him, left him a voicemail saying to call me back ASAP, sent him a text to call me back ASAP, tried calling him again, and finally established connection 20 minutes later. I also sent him a picture of the xray, he said he was driving back to the hospital now and to please tell the patient.

Great.

The patient was surprisingly nice about it, I told her what happened, she said "shit," and I said "yeah, that's pretty much what I said." Her daughter and husband were not quite as understanding, so I figured the learning experience in all this was to only deliver bad news when people are waking up from general anesthesia. I showed them the xray, they demanded to know how this happened. Um, good question. They also demanded to know what we would do if the revision didn't work. Um, equally good question. I would say try Plan C, but they would probably ask me what that was and I didn't really have a great answer. I could probably make up something and use enough scientific terminology that they wouldn't question it, but that seemed a tad unethical.

Dr. Grandpa showed up an hour later and we took the patient back to the OR to start the surgery.

The problem was, when we got in there and discovered there was a huge chunk missing from the hip socket, Dr. Grandpa decided to use trabecular augment. Which is not the wrong thing to do in that situation, except we don't keep trabecular augment at this hospital. We don't even keep it in this city. So the patient got an extra hour of general anesthesia and Dr. Grandpa and i played 6 games of tic-tac-toe with the sterile pen. (all ties) Then the scrub tech and i played hangman with the sterile pen until the sterile pen ran out of ink and we thumb wrestled in sterile gloves. Then Dr. Grandpa told us to knock it off so we stood there and stared at each other until someone put the radio on.

So yeah, the whole day went a lot longer than expected. but at least the patient had her surgery and she seemed to be doing OK this morning. So fingers crossed this works, because if not, well, I guess we have to come up with a plan C.