Week 3: Katelyn

This week was the third week of immersion and I have continued to experience a variety of opportunities this week.

For research this week, I finished sorting through the patient scans to determine the presence of metal. From this group (391), I went through and excluded individuals with metal near the knee, resulting in a final patient cohort of 311. The next step is to do the image segmentation of the patient scans to separate the femur and tibia. I just received access to the desktop and software, so this task will continue into next week.

During the clinic this week, I saw a wide array of patients including bone health work-ups, pain follow-ups, THA post-ops, TKA post-ops, and others. Of all these cases, the ones that stood out to me were a sacral fracture patient, a perthes disease patient, an osteochondroma patient, and a bone health work-up patient. The sacral fracture was particularly interesting because it occurred during labor. During pregnancy and lactation, there is an increased demand for calcium throughout the body often resulting in the bone breaking down its mineral to increase blood calcium levels. While I have read about this occurring, it was intriguing to see the impact of this phenomenon in person. The perthes disease was also interesting because this pathology results in the collapse of the femoral ball. This change in the hip shape occurs during childhood, but leaves the hip permanently deformed. Curiously, this patient has only recently had an increase in hip pain and will soon need a hip arthroplasty. The osteochondroma patient was interesting because this pathology results in a bony outgrowth covered in cartilage. This benign tumor typically occurs during development and often occurs near the growth plate. Interestingly, these tumors do not need to be remove unless the patient is experiencing pain. This particular patient has had this tumor for majority of their life and has more recently been developing pain because of it. Finally, the bone health workup patient was an intriguing case to see. This particular patient had a history of Crohn's, an ED, GAD, and OCD. The patient recently underwent a surgery where the surgeon noticed the bone was softer than anticipated, sending them to do a bone health workup. This initial workup indicated low bone mass despite the patient's proximity to peak bone mass age (~30-35yo). Similarly to how insufficient caloric intake can result in the loss of menstruation, such insufficiencies also have a negative impact on the bone. More specifically, the body is unable to maintain bone mass because it is not metabolically 'safe' to do so. Despite the ED being resolved, the occurrence in adolescence can prevent individuals from achieving an anticipated bone mass by the age of ~30-35yo. Additionally, the patient's history with Crohn's contributed to the malnutrition and also included the use of steroids which also negatively impact bone health. Overall, such cases are interesting to see because it emphasizes the importance of being proactive with your bone health.

In the OR this week, I saw total hip arthroplasties (THA). I saw one of these procedures last week, so it was interesting to see what parts of the procedure change with patient variability and what stays consistent. While I am more familiar with this procedure now, there were still new things that I picked up on while observing. Not only are there different implant sizes, but there are different femoral neck offset sizes. These offsets are important because they determine the angle of the femoral neck. Another important aspect of the surgery is the variability of sizes between radiological measurements and actual measurements. While the imaging may suggest a particular size for the implant, these measured sizes might not be suitable for the patient during the trialing of sizes, largely due to the patient's anatomy and bone quality.