Week 5: Katelyn

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

For research this week, I continued to segment the patient scans. As mentioned previously, the primary goal of this segmentation is to isolate the patient's distal femur from the CT scans. Once the distal femur is segmented, the greyscale values from the segment is exported as a txt file to be used for the BMD analysis.

During the clinic this week, I saw a wide array of patients including bone health work-ups, pain follow-ups, post-ops, and others. Of all these cases, the one that stood out to me was a femur cyst patient. This patient was rather young and the cyst was caught on an MRI after a sports injury, at which point they were referred to Dr. Hansen. The cyst is located within the proximal femur, primarily in the trochanter and extending into the femoral neck. The MRI also revealed labral fraying. The patient was experiencing significant pain in their groin area (associated with hip pain), which could be due to either of the findings. To determine where the pain is coming from, a diagnostic injection (steroid shot) of the hip joint can be performed. If the injection improves the pain, then the source of pain is the labrum. If there is no improvement in pain, then the source of the pain is the cyst. Regardless of the pain origin, the cyst still needs to be treated as the location is in a highly stressed area of the femur. This cyst impacts the strength of the bone in this area and thus increasing the likelihood of fracture. The two treatment options to treat this include a conservative approach with moderate success and a more invasive approach with high success. The conservative approach would be to take bone marrow aspirate (BMA) from the iliac crest and inject it into the cyst. The recovery for this would include 6wks of no weight bearing. The more invasive approach would be to create a window into the bone and scrape out the cyst and put in bone graft material to reinforce where the cyst was. The recovery for this would include 6wks of no weight bearing and a slower transition to exercise. Although both are options, if the conservative approach doesn't work after 2 attempts, then the more invasive approach must be used. Until the procedure/surgery occurs, the patient is not allowed to exercise.

In the OR this week, I saw hip hemiarthroplasties (HHA). This procedure is a partial hip replacement, only replacing the femoral portion of the hip and leaving the socket intact. Such procedures are commonly used for complete femoral neck fractures, which is when the fracture goes through the entirety of the femoral neck, thus separating the femoral head from the shaft. These types of fractures occur more commonly in older patients and as such it is common to use cemented implants. The procedure itself consists of removing the femoral head and sawing off any remnants of the femoral neck. At this point, the acetabular cup size is measured by using trial sizes in the native socket. Then, the femoral shaft is drilled and the femoral insert is trialed. Once this sizing is selected, the drill hole is cleaned and the cement is prepped and injected into the femoral shaft. The femoral stem is then inserted and held for 10-15minutes while the cement hardens. The ball and neck sizes are then trialed and inserted along with the acetabular cup. Interestingly, since the native socket is left intact, this surgery does not require the usage of x-ray in the OR since THA use x-rays to check socket placement.

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