Take Trauma Call With Me

Antonio Webb, MD, is a San Antonio-based orthopedic surgeon. Join him as he reviews several of the 19 surgeries completed in 1 week of being on call.

The following is a partial transcript (note that errors are possible):

Web: My video is really screwing up. You can see the patient on their side. I already put my spacer in basically to take the pressure off the spinal canal and help fuse that area. Then the screws are moving and the robotic arm is actually going and specifically the direction I want it to go. Then, I screwed up. I go through the robotic arm to insert the screw into the spine. It’s very accurate. It’s very accurate. Last week, I completed 19 surgeries on call. In today’s video, I am going to tell you about some such cases and tell you how my call went.

what’s up everyone? This is Dr. Webb here. Thanks for watching this video. Make sure you subscribe. A new video is coming every week. You don’t want to miss them.

Those who are new to the channel are welcome. I am an orthopedic surgeon here in San Antonio, Texas. I focus mostly on spine surgery – I am fellowship-trained in spine surgery – but I also take general orthopedic trauma calls.

Last week was a very busy week. I was tormented by trauma cases and too many elective cases. In this video we are going to talk about some such cases. I’ll talk to you and tell you how I do the surgery, a little bit about the details of the surgery, but the details, whether it’s male or female, or the age of the patient, or their x-ray images, or just the images that I found online. I try to be as specific as possible about what the patient most resembles and what their postoperative images are. These are not pictures of the real patient. I changed the history a lot for patient privacy, but you guys enjoyed the last video. We’re going to jump in.

This is essentially a list of cases that I did last week. I actually did 19 of them. These are the general orthopedic cases, the trauma cases at the top, and some alternative cases at the bottom, the spinal cases that I did. But we will learn and talk about some of these.

The first consultation I received was a 62-year-old male who presented to the emergency room after falling and falling at home. He presented with this femoral neck fracture. When you look at these X-rays here, for a normal person, you can see and not even see the fracture. Or you can look at one and I’m like, “Man, you can do a little better than some medical students or even residents and miss this fracture in here.”

This type of fracture is called a valgus-affected femoral neck fracture. Only the direction of the fracture line and the position of the femoral neck. It is in Valgus. We spoke to the patient about the various options, whether to undergo surgery or not to undergo surgery. This patient was selected, we both agreed that this patient needed surgery.

You can see the fracture line a little more clearly here. I drew it for you right here in this yellow line. But in general, for a femoral neck fracture, it depends on the patient’s age, their activity level, and their surgeon’s level of comfort in terms of certain procedures. But, in general, we can do a partial hip replacement, which is called a hemiarthroplasty or a full-hip replacement.

You might not think that patients who come to the ER and have a broken hip are getting a complete hip replacement. But if they are high-activity, if they have arthritis on either side of the joint, they may be better candidates for a total hip replacement.

Then in patients who have really minimal displaced fractures in the femoral neck, especially a young patient, we try what’s called, pin these, closed reduction percutaneous pinning. That’s what CRPP is for.

But there are many types of fractures. The red here is the intertrochanteric region. This is your big piece. This is your low troche. This is the subtrochanteric region. Then it’s the femoral neck area here. You can have femoral head fractures that are treated completely differently.

But, in general, for femoral neck fractures, this is usually the option we offer to patients. If a patient has an intertrochanteric fracture, we treat it with a metal rod called a cephalomedullary nail, or if they have a subtrochanteric fracture, most of these are treated with cephalomedullary nails or intramedullary rods . These rods that go inside the bones that stabilize it, allowing them to get up and walk again.

These are some pictures of Closed Reduction Percutaneous Pins. These are the pins that go inside the bone here and stay inside forever. Then it’s the cephalomedullary rod here. It is a long one that spans the entire side of the femur here. These are some of the screws that basically stabilize the rod here. It looks like it is one of the systems when it is not inside the bone.

Then I chose to do the same for this gentleman. We spoke with him about hip replacement. He was a little older and he was not really active. I thought this fracture could be treated with hemiarthroplasty, partial hip replacement or here this small blade system that actually stabilizes the fracture.

But, you know, the downside of that, it can fail, which means he walks on it, can break, then we have to do a hip replacement. But I figured the least invasive option was to do it first. I wanted to quickly on and off this gentleman in the OR of the operating room table.

He had some co-morbidities, heart problems and pulmonary problems which required us to have an early surgery. This surgery probably took me 35 minutes or more, 30 minutes, and we were able to fix this fracture.

This is what it looks like here. It comes with a small plate. I actually put two screws down here. It has a bolt and then a screw that goes up so it doesn’t spin. But this is a fairly common fracture. If you ask 10 different orthopedic surgeons whether they’re trained in joints, which means they do a lot of hip replacements, or if they’re trauma-trained, you’ll probably get a reference on how to fix these. You will get 10 different answers. But we will follow it for a few months and make sure it gets fixed. We will go from there.

The next patient consultation I got was a gentleman who had fallen off the roof. He came in with a really swollen leg. His foot was two to three times the size of the foot on the other side. He had what were called fracture blisters. These are small blisters here, and they come out due to swelling. We don’t do anything about it, but I find it strange that a lot of people find it weird when they see all these blisters on the feet here.

But those blisters just mean that there’s a lot of inflammation. When this happens, it means we can’t do definitive surgery, which would be a plate and a few punctures, until the swelling subsides, simply because that’s what happens when we try to close the wounds. It can be very challenging to do. Too much inflammation can cause a lot of problems.

What I did was a temporary surgery. I went in and I installed an external fixator. An external fixator is a device that holds a bone in place. We sometimes leave it for 10 to 14 days till the swelling subsides and then we can take the patient back for surgery to do definitive surgery.

Antonio Webb, MD, is an orthopedic resident surgeon in San Antonio, as well as an author and motivational speaker who has a passion for helping others. She . is the author of overcome obstacles, and host a Youtube channel,

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