Antonio Webb, MD, is a San Antonio-based orthopedic surgeon. Join him as he reviews several of the 19 surgeries he completed in 1 week of being on call.
Following is a partial transcript (note that errors are possible):
Webb: Video of me actually putting in the screw. You can see the patient’s on their side. I already put my spacer in to basically take the pressure off of the spinal canal and help that area fuse. Then the screws are going and the robotic arm is actually going and specifically the direction I want it to go. Then, I put the screw. I go through the robotic arm to put the screw into the spine. It’s very precise. It’s very accurate. Last week, I completed 19 surgeries on call. In this video today, I am going to walk you guys through some of those cases and let you know how my call went.
What’s up, everyone? This is Dr. Webb here. Thank you for watching this video. Make sure you subscribe. A new video is coming every week. You don’t want to miss them.
For those that are new to the channel, welcome. I’m an orthopedic surgeon here in San Antonio, Texas. I focus mostly on spine surgery — I’m fellowship-trained in spine surgery — but I also do take general orthopedic trauma call.
Last week was an extremely busy week. I got pretty slammed with trauma cases and also a lot of elective cases. In this video, we are going to talk about some of those cases. I’ll talk to you and walk you through how I approach the surgeries, a little bit about the details of the surgery, but the specifics, whether it’s male or female, or the patient’s age, or their x-ray images, or just images that I found online. I try to be as specific as possible in terms of what most resembles what the patient had and also what their postoperative images are. These are not the real patient’s images. I changed the history a lot for patient privacy, but you guys enjoyed the last video. We’re going to jump into this one.
This is a list of essentially the cases that I did last week. I actually did 19 of them. These are general orthopedic cases, trauma cases at the top, and also some elective cases at the bottom, spine cases that I did. But we’re going to go through a couple of these and just talk about them.
The first consult that I got was a 62-year-old male who presented to the emergency room after he tripped and fell at home. He presented with this femoral neck fracture. When you look at these x-rays here, for the lay person, you may look and not even see a fracture. Or you may see one and I’m like, “Man, you can do a little bit better than some of the medical students or even residents and may miss this fracture here.”
The type of fracture that this is, this is called a valgus-impacted femoral neck fracture. Just the direction of the fracture line and the way that the femoral neck sits. It’s in valgus. We talked to the patient about the different options, whether to undergo surgery or to not undergo surgery. This patient elected, we both kind of came together in agreement that this patient needed surgery.
You can see the fracture line here a little bit more evident. I kind of drew it out for you in this yellow line right here. But in general, for a femoral neck fracture, it depends on the patient’s age, their activity level, and their surgeon’s comfort level 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 may not think the patients who come in to the ER and they break their hip, they are getting a full total hip replacement. But if they are high activity, if they have arthritis on both sides of the joint, then they may be a better candidate for a total hip replacement.
Then patients who have really minimally displaced fractures in the femoral neck, especially a young patient, we try to, what’s called, pin these, closed reduction percutaneous pinning. This is what the CRPP is.
But there are lots of different types of fractures. The red right here is the intertrochanteric region. This is your greater troch. This is your lesser troch. This is the subtrochanteric region. Then this is the femoral neck region right here. You can have femoral head fractures that are treated totally separate.
But, in general, for a femoral neck fracture, this is usually the options that we give 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 on the inside of the bones that stabilize it, so they can get up and walk again.
These are just some pictures of the closed reduction percutaneous pins. These are pins that go inside the bone here and they stay in forever. Then this is the cephalomedullary rod here. This is a long one that spans the entire portion of the femur here. These are some screws that basically stabilize the rod here. This is what it looks like, sort of one of the systems when it’s not inside the bone.
Then this is what I elected to do for this gentleman. We talked about a hip replacement with him. He was a little bit older and he wasn’t really active. I felt like this fracture could have been treated with a hemiarthroplasty, partial hip replacements, or this little blade system here that actually stabilizes the fracture.
But, you know, the downside of this, this could fail, which means he walks on it, could fall apart, then we have to do a hip replacement. But I felt like doing the least invasive option first. I wanted to get this gentleman into the OR quickly and off of the operating room table.
He had some comorbidities, heart problems and pulmonary problems that we needed to do the surgery quickly. This surgery probably took me, I don’t know, 35 minutes or so, 30 minutes, and we were able to fix this fracture.
This is what it looks like here. It comes with a little plate. I actually put two screws down at the bottom here. It has a bolt and then a screw that goes up so it doesn’t rotate. But this is a pretty common fracture. If you ask 10 different orthopedic surgeons whether they are joints-trained, which means they do a lot of hip replacements, or if they’re trauma-trained, you’ll get probably 10 different answers in terms of how to fix these. But we’ll follow this out for a few months and make sure it heals. We’ll go from there.
The next patient consult that I got was a gentleman who fell from a roof. He came in with a really swollen leg. His leg was two to three times the size of the leg on the other side. He had what are called fracture blisters. These are little blisters here, and they pop up because of the swelling. We don’t do anything about this, but I find it funny that it freaks a lot of people out when they see all these blisters on the leg here.
But those blisters just mean that there is a lot of swelling. When this happens, that means we can’t do the definitive surgery, which would be a plate and some screws, until the swelling goes down, just because when we try to close the wounds it may be very challenging to do that if there is a lot of swelling and can lead to a lot of problems.
What I did was a temporizing surgery. I went in and I put an external fixator. An external fixator is a device that holds the bone in place. We sometimes leave it in place for 10 to 14 days until the swelling goes down and then we can take the patient back to surgery to do the 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. He is the author of Overcoming the Odds, and hosts a YouTube channel.
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