Orthopedic Shadowing Journal
date: 01-03-25
procedure: Right carpal tunnel release
date: 01-03-25
procedure: Left distal radius fracture malunion correction
- Age matters, less leniency for re-alignment since bones are not as dense??
date: 01-03-25
procedure: Right thumb metacarpal fracture open reduction internal fixation versus closed reduction percutaneous pinning / left distal radius fracture open reduction internal fixation. (Left) left distal radius fracture open reduction internal fixation
date: 01-03-25
procedure: (Right) Right wrist removal hardware / anterior interosseous neurectomy / posterior interosseous neurectomy
- neurectomy doesn’t affect grip strength
date: 01-03-25
procedure: Left Revision Carpal Tunnel Release / Hypothenar fat pad flap / left cubical tunnel release / possible anterior transposition
date: 9/17/24
procedure: Right Wrist Extensor Tenosynovectomy (Ganglion Cyst Excision)
• What it is: A procedure to remove a ganglion cyst from the extensor tendons of the wrist, and possibly the inflamed tendon sheaths (tenosynovectomy) if necessary.
• Nerve Block: A Wrist Block is typically performed, anesthetizing the radial, ulnar, and median nerves. Sometimes a brachial plexus block (usually a supraclavicular block) is used for more proximal anesthesia.
• Injury Cause: Overuse of the wrist or irritation of the extensor tendons leads to the development of a ganglion cyst.
• Recovery: Recovery takes about 2-6 weeks. Initial rest and splinting are followed by physical therapy to regain function and strength.
• Surgical Process: The surgeon will carefully dissect around the extensor tendons to excise the cyst and remove inflamed synovial tissue. Care is needed to avoid the radial artery and extensor tendons.
Questions to Ask:
• “How do you differentiate between a ganglion cyst and other soft tissue masses before excision?”
• “What’s the typical recurrence rate after a tenosynovectomy for this condition?”
• “How do you prevent damage to the radial artery during this procedure?”
date: 9/17/24
procedure: Right Proximal Humerus Fracture Open Reduction Internal Fixation (ORIF)
• What it is: A surgical procedure to stabilize and fix a proximal humerus fracture (upper arm) using plates, screws, or rods.
• Nerve Block: A Brachial Plexus Block (usually interscalene) is common for shoulder surgeries. This provides regional anesthesia and can control pain postoperatively.
• Injury Cause: Typically caused by falls or direct trauma to the shoulder.
• Recovery: Recovery can take several months. Immobilization is followed by physical therapy to restore range of motion and strength. Full recovery may take up to a year.
• Surgical Process: The surgeon will reduce the fracture and stabilize it with hardware. Care is needed to avoid injury to the axillary nerve, suprascapular nerve, and posterior circumflex humeral artery.
Questions to Ask:
• “How do you ensure proper alignment and fixation of the humerus during surgery?”
• “What are the common risks of nerve injury, particularly to the axillary nerve?”
• “How do you assess the patient’s shoulder range of motion postoperatively?”
date: 9/17/24
procedure: Right Clavicle Fracture Open Reduction Internal Fixation (ORIF)
• What it is: Surgery to fix a fractured clavicle using plates and screws.
• Nerve Block: A Brachial Plexus Block (typically interscalene or supraclavicular) is used for anesthesia and pain management.
• Injury Cause: Clavicle fractures usually occur from falls on the shoulder or direct trauma.
• Recovery: The patient may need to wear a sling for 4-6 weeks and begin physical therapy afterward. Full recovery can take several months.
• Surgical Process: After making an incision over the clavicle, the surgeon will reduce the fracture and stabilize it with a plate and screws. Key anatomical structures like the subclavian vessels, brachial plexus, and suprascapular nerve must be protected.
Questions to Ask:
• “What are the main risks when operating near the subclavian vessels?”
• “How do you determine the best approach to fixating a clavicle fracture based on its location?”
• “What complications are most common post-clavicle ORIF?”
date: 9/17/24
procedure: Left Trapeziectomy and Suspensionplasty
• What it is: A procedure that involves removing the trapezium bone (one of the wrist bones) and stabilizing the thumb joint with surrounding tendons (suspensionplasty) to treat arthritis or other degenerative conditions in the thumb.
• Nerve Block: A Wrist Block targeting the radial, median, and ulnar nerves may be used. Sometimes a brachial plexus block (interscalene or supraclavicular) is performed for more extensive anesthesia.
• Injury Cause: Arthritis in the base of the thumb, trauma, or degeneration leads to pain and loss of function.
• Recovery: The patient may wear a cast for 4-6 weeks followed by physical therapy. Full recovery might take several months.
• Surgical Process: The trapezium bone is removed, and the joint is stabilized using a portion of a tendon (often the flexor carpi radialis tendon). Key structures to avoid are the radial artery and superficial radial nerve.
Questions to Ask:
• “What are the long-term functional outcomes after trapeziectomy with suspensionplasty?”
• “How do you ensure joint stability when performing suspensionplasty?”
• “Are there any alternatives to trapeziectomy for treating thumb arthritis?”
date: 9/17/24
procedure: Left Lateral Malleolus Fracture Open Reduction Internal Fixation (ORIF)
• What it is: Surgery to stabilize a fractured lateral malleolus (the outer ankle bone) using plates and screws. If syndesmosis is involved, the surgeon may also repair this ligament.
• Nerve Block: An Ankle Block can be used for anesthesia, targeting the saphenous nerve, superficial peroneal nerve, deep peroneal nerve, sural nerve, and tibial nerve. A popliteal sciatic block is often used for more proximal anesthesia.
• Injury Cause: Typically caused by twisting the ankle or a direct blow, leading to fractures and possible disruption of the ankle ligaments (syndesmosis).
• Recovery: The patient may need to be non-weight-bearing for 6-8 weeks, followed by gradual weight-bearing and physical therapy. Full recovery can take several months.
• Surgical Process: The surgeon will reduce the fracture and stabilize it with plates and screws. If there is syndesmosis disruption, additional screws or a tightrope procedure may be used. Key anatomical structures to avoid include the superficial peroneal nerve and posterior tibial tendon.
Questions to Ask:
• “How do you assess syndesmosis integrity during surgery?”
• “What are the key differences between repairing a simple fracture and one involving the syndesmosis?”
• “What complications can arise if the syndesmosis is not properly repaired?”
date: 09-12-2024
procedure: Dorsal Wrist Ganglion Excision
What it is: Removal of a ganglion cyst, which is a fluid-filled sac that commonly appears on the back (dorsal side) of the wrist.
Injury Cause: Ganglion cysts are usually caused by joint irritation or damage to the wrist tendons. Sometimes, they develop spontaneously.
Recovery: Patients often have full recovery within 2-6 weeks. They may need to wear a splint initially, followed by physical therapy to regain strength and range of motion.
Surgical Considerations:
The surgeon must be cautious of the extensor tendons (run just underneath the skin along the back of the hands and wrists. They control the hand’s ability to straighten the fingers and wrists.) and radial artery (a major blood vessel that supplies oxygenated blood to the hand, wrist, and forearm) to avoid damaging them.
Proper identification of the cyst stalk is crucial for full excision to reduce the risk of recurrence.
Questions to Ask:
“What is the recurrence rate of ganglion cysts post-excision?”
“How do you ensure that the cyst is completely excised to prevent regrowth?”
“What are the possible complications related to this procedure?”
date: 09-12-2024
procedure: Trigger Finger Release
What it is: This procedure releases the A1 pulley in the finger, which is thickened and causing the finger to lock or trigger.
Injury Cause: Repetitive gripping or tendon inflammation can cause thickening of the pulley, leading to trigger finger.
Recovery: Patients usually regain full function within a few weeks, but they may need to avoid heavy hand use during early recovery. Splinting and stretching exercises might be part of rehabilitation.
Surgical Considerations:
Careful dissection is needed around the flexor tendons (cord-like structures running from the forearm across the wrist and palm and into the fingers) to avoid damage.
Protecting the digital nerves (nerves pass messages to your brain about what you can feel) is critical, as they run close to the pulley being released.
Questions to Ask:
“How do you protect the digital nerves during this procedure?”
“What postoperative therapy is typical after trigger finger release?”
“Are there any long-term complications that can arise after this surgery?”
date: 09-12-2024
procedure: Cubital Tunnel Release
What it is: Surgery to relieve pressure on the ulnar nerve (sensorimotor nerve that runs from the neck down the arm and into the hand), which runs through the cubital tunnel on the inside of the elbow, often compressed causing numbness or weakness in the hand.
Injury Cause: Repeated elbow flexion, direct trauma, or prolonged pressure on the elbow can cause compression of the ulnar nerve.
Recovery: Recovery can take several weeks to months, depending on nerve damage. The patient will need to avoid activities that strain the elbow and may undergo physical therapy.
Surgical Considerations:
The surgeon must protect the ulnar nerve during decompression and avoid injury to surrounding structures like the medial epicondyle (a bone on the upper arm where the forearm muscles attach and where ligaments that stabilize the elbow originate) and flexor muscles.
Properly identifying the anatomy is crucial to avoiding nerve damage.
Questions to Ask:
“How do you determine whether to use a simple decompression versus an anterior transposition?”
“What are the potential risks of permanent nerve damage during this procedure?”
“What factors affect the recovery of nerve function post-surgery?”
date: 09-12-2024
procedure: Rotator Cuff Repair (Arthroscopic)
What it is: A minimally invasive surgery to repair tears in the rotator cuff tendons, which stabilize the shoulder joint.
Injury Cause: Rotator cuff tears can result from repetitive shoulder movements, heavy lifting, or trauma, especially in athletes or older adults.
Recovery: Recovery can take several months, with initial immobilization followed by gradual physical therapy to restore strength and mobility. Full recovery might take up to a year.
Surgical Considerations:
The surgeon must work near critical structures such as the axillary nerve (a peripheral nerve that runs from the neck through the shoulder and helps with movement and sensation in the upper limb), suprascapular nerve (a mixed sensory and motor nerve that originates in the upper trunk of the brachial plexus and provides sensory and motor functions to the shoulder), and subacromial space (helps to reduce friction between these structures of the shoulder complex).
Identifying and securing the tendon properly is crucial to ensure healing.
Questions to Ask:
“What are the most common challenges in repairing a rotator cuff tear arthroscopically?”
“How do you assess the integrity of the repair intraoperatively?”
“What are the factors influencing healing rates in rotator cuff repairs?”
date: 09-12-2024
procedure: Distal Radius Fracture (Open Reduction Internal Fixation)
What it is: A surgical procedure to stabilize and fix a fractured distal radius (the larger bone in the forearm near the wrist) using plates and screws.
Injury Cause: Commonly caused by falls onto an outstretched hand, leading to fractures near the wrist joint.
Recovery: Patients typically recover over 6-12 weeks, with an initial period of immobilization followed by physical therapy. Some patients may regain full function after several months, depending on the severity of the fracture.
Surgical Considerations:
The median nerve and radial artery are close to the operative field and must be carefully protected.
Restoring the proper alignment of the radius is crucial to ensure normal wrist function postoperatively.
Questions to Ask:
“How do you ensure proper alignment and fixation during ORIF of the distal radius?”
“What are the common complications following distal radius ORIF?”
“How do you assess the need for additional soft tissue repairs during this procedure?”
date: 5-17-24
Reflections
- Return to sport rate and patient reported outcomes to give the athletes a better idea of what their recovery outcome can be like
- Condition depends / strength demands
- Rates for different surgery
- Impact of biomechanics from surgery
- Different sports - different athletes - different demands - sports specific data is important
- Research is helpful in educating patients and engineering something better
date: 3-28-24
Reflections
Observations
- Arthroscopic Surgery
- Patient had a torn meniscus - cleaned up the edges of the flaps of the torn meniscus with mini shaver to prevent getting caught when bending the knee which was most likely causing the pain, and cleaned surrounding damaged / inflamed tissue.
Reflections
date: 12-21-23
procedure:
Observations
- Open surgery
- 3cm displacement of fractured clavicle
- assessed open clavicle fracture to understand its complexity, including its displacement and and loose bone fragments.
- Made plan for restructuring the clavicle bone.
- Proceeded to select appropriate size plate for patients’ clavicle, ensuring that the patients’ clavicle is properly supported and stabilized during the healing process.
- Used k-wire for temporary fixation of the major fragments of the fracture before the definitive fixation is.
- Used lag screws to properly fixate the clavicle fracture with the plate and removed k-wires from the bone.