Week 2 day 7

No frames today, due to few patients being eligble. I spent the day within theatre 4, watching multiple ORIF's. The one most interesting was a distal humerus spiral fracture, that required 2 plates either side of the distal humerus just above the epicondyles.

http://us.synthes.com/.

This procedure was very messy, in terms of incision due to the patients size. Although there were no other fracture than the distal humerus, a very difficult procedure to repair the fracture. The position of the patient was prone, so breathing had to be monitored regulary, she was middle aged but very habatus, alot of pressure on the chest.

Care has to be taken when drilling into bone or soft tissue, intermittant drilling is the best approach. Thermal necrosis of the bone or soft tissue can become necrotic from the friction of the drill bit. When a frame is being applied the wire is held via the drill chuck but also guided into the body and held by a swab of alchohol. The alchohol swab will cool the skin as the wire enters, to make sure it cools, the intermittant drilling allows controled cooling, so not burning the skin or bone.

Thermal Necrosis is more common when an Intermedullary Nail is inserted, although it cannot be ignored during any operation that requires a drilling tool.