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Monday, March 22, 2010

We Live in Good Times

Post provided by Barbara Bergin, MD

It’s really amazing to see all the external fixators being used in Haiti. That surgical procedure has revolutionized the treatment of open fractures (broken bones which have penetrated through the skin or have had something penetrate the skin to contaminate them).
I can remember in my residency (early 1980s) we were treating open fractures in traction or with casts. We would cut big holes in the casts so we could have access to the wounds in order to clean them. We had to fashion little doors out of the cast material so we could get to them a couple of times a day. The little “doors” were needed because if you just left a hole in the cast, the injured skin and muscle would swell up into the hole, like rising bread, and then you’d have a bigger mess on your hands.

I can tell you that there were a lot less open fractures back then. We just didn’t see the number of high energy trauma cases we see now; motorcycles and high speed car accidents were not as common. We also did a lot more amputations! Without external fixators, we just couldn’t take care of the wounds like we can now! External fixators were in the making though. Orthopods are tinkerers and we would put big pencil-sized pins through the bones above and below the break and then hold them apart by making outriggers of twisted plaster over wire, or whatever interesting polymer we could find around the operating room or the mechanical room in the basement of the hospital.

While I did my rotations at the Veteran’s Administration hospital, I saw many veterans of WWII with chronically infected wounds they received while fighting in the European and Pacific fronts. Sometimes, instead of having amputations, they would opt to keep their legs, but the exposed bone would have become infected. If the bone healed, despite the infection (most of the time infected bones won’t heal) then they would just spend the rest of their lives with pus draining out of their leg. They would walk around with big dressings covering the hole in their leg in order to absorb all the liquid that poured out! It was really quite incredible. Our veterans were in their 60s then! Imagine young men suffering those wounds in their 20s and living with them that long. They would keep that leg along with all its problems, rather than have an amputation.
Then to add insult to injury, chronically infected wounds are susceptible to getting a form of skin cancer, so we always had to check them for that. By the 80s, those veterans had been walking around with their wounds for about 40 years!

Now just because we can put external fixators on the unfortunate folks in Haiti, it doesn’t mean they’re all going to get to keep their legs. Nor does it guarantee them to be free of the potential for infection, but it sure gives them a better chance than if we weren’t using them. We do live in good times.

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