Week 2: Katelyn

This week was the second week of immersion and was truly spread out in what it entailed. Throughout the week, I experienced the OR, the clinic, and research. 

The first OR day I saw a total knee arthroplasty (TKA) and a total hip arthroplasty (THA). I had a good amount of familiarity with the steps of the procedures which was helpful for observation. In particular, I knew that the implant sizes needed to be trialed before they could actually fix the implants. Practically this meant that there were a lot of different implant sizes available in the OR and that my clinician had to do range of motion and stability testing with the different sizes. Since it would be inefficient to try each and every one of the sizes, they start out with sizes based on the pre-op imaging. I was especially fascinated by the variety of specialized equipment used for the surgeries. The different implant pieces (e.g. acetabular cup vs femoral stem) had different equipment needed for proper placement. The equipment used during these surgeries were modular pieces that allowed for the lowest number of pieces. For instance the drill used was able to be converted from a typical drill to an acetabular reamer. The second OR day I saw a core decompression of the hip and a closed reduction with percutaneous pinning (CRPP) of the left hip. The setup for these were different to the previous day as only a minor incision was made to allow for drill access. Additionally, the x-ray machines (one anterior-posterior and one laterally) were kept in place for the entirety of these procedures. This placement allowed for checking the placement of the wires, drill head, and screws throughout the procedure. The screws used for the CRPP case only come in intervals of 5mm which makes choosing screw length size more complicated than necessary. Overall, it was very interesting to see all the biomedical devices I've learned about applied in real-time as well as the clinicians' perspective of these technologies. 

During the clinic this week, I saw a pathology that I had not heard of before called tenosynovial giant cell tumor. These tumors are benign in nature, though surgery for removal is common as it causes inflammation which can speed up the progression of osteoarthritis in the joint capsule. I also saw a case of post-radiation fracture in the femur. The fracture occurred years after radiation treatment and was a low energy fracture that resulted in an oblique femoral fracture. The fracture was initially treated with an internal fixation rod, but the fracture is still nonunion despite being months post-op. The treatment plan for this patient was to repeat scans to confirm no healing and once confirmed, then an additional surgery will be necessary. The surgery would use a magnetic rod that is typically used for leg lengthening procedures, but instead of activating the rod to act in tension, it would be fully extended and then compressed over time to form union between the two pieces of the fracture. 

Additionally, I got to sit in on the weekly surgical case review. During this meeting, the residents and attendings discuss the cases and their surgical approach. One of the topics of discussion was the screw placement used in intertrochanteric fracture. This fixation approach uses 3 screws through the femoral neck. Some of the surgeons believed the nondivergent placement was better, but others were concerned about nicking one of the blood vessels and thus increasing the odds of avascular necrosis developing. To avoid such complications, using divergent placement of the screws while avoiding the proximal femoral cortex and the high stress area distal to the femoral neck. This discussion was particularly interesting as Dr. Hansen had a CRPP case in the OR that day. 

For research this week, I got clearance for using the PACS system for viewing images. The first step to the study is to sort through the patient scans to determine if they have metal near the knee. Having metal in or near the knee would cause an imaging artifact that would impact the fidelity of the BMD calculations later on. We are aiming to have a total of 125 M and 125 F patients for the study, so I need to sort through more than 250 to account for the patients that will ultimately be excluded due to imaging artifacts. So far, I have sorted through approximately 250 of the scans and have 142 scans remaining. 

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