7/2017
Orthopedic Surgeons are structural engineers, essentially. They design and install the components that are required to keep a person erect and ambulatory. That being said, they work on bones. To evaluate bones, in modern medicine, they need x-rays. This allows them to see the damage to the bone, the structural component. In the “old days”, like before about 2002, most orthopedists did not have the capability of viewing x-rays in real time and had to come into the hospital and physically look at the image on a piece of celluloid, or rely on the consulting docs verbal description.
In training, we (us doctors) all learned how to describe x-ray findings to another physician in anticipation of this. It is very logical, compulsive, thorough and defined. Let me describe what I mean by describing my patients x-rays as I described it to the orthopedist.
The tibia (the big bone in the leg below the knee) is fractured (broken) in a comminuted fashion (involving multiple pieces) with no angulation (not listing to one side or the other, or straight in the axial dimension) and 100% displaced (one end of the bone overlapping the other through the longitudinal axis). There is an open wound over the fracture (a laceration of the overlying skin). The fibula (the skinny bone in the leg) is essentially the same, broken and displaced. I attempt to explain in layman’s terms with the comments in parentheses.
With a description like this, the orthopedist can quickly come to the conclusion that the patient needs to go to surgery and pretty soon. The longer the delay the more likely an infection of the bone and therefore, more likely a poor outcome.
So, I had this little old lady who fell on the stairs and broke her leg as described above. I called the orthopedist on call and gave him this great description of the x-rays, the wound and the case. I won’t torture you with a blow by blow detail of what he said, just that he did his best to get me to say that I was exaggerating my reading and that the injury was not as severe as I implied. I would not back down. He also whined that he could not see the x-ray on his home monitor. Like I could do anything about that?
When he came through the ED, I casually asked him if he had had a chance to look at the x-rays, and he said, “Yeah, they look like shit. I’m taking her to surgery.”
No shit!
I’m just waiting until the next time I get to call him about a patient with a bad break of some bone. I’m gonna call him up and tell him that the x-ray looks like shit and the patient needs to go to surgery.
I need to keep up with the times, techno-lingually speaking that is.
From your grumpy Uncle/Brother Dave.
Weary.