Author: alexg543

Today was my final day in clinic with Dr. Schweitzer. It was a busy day as there were about 45 patients on the clinic schedule. Today there were many post-operation patients that we met with. It was very interesting to meet with patients that we had diagnosed in previous weeks. For example, last week we diagnosed a patient with an achilles rupture. There are two methods to diagnose an achilles rupture. The first is to feel for tension in the achilles (no tension= ruptured achilles). For the second method, the patients must be laying on their stomach with their feet in the air and the knee bent. Then, a doctor can squeeze the calf muscle. If the foot moves when the calf is squeezed, the achilles is still intact. If there is no movement in the foot then the achilles is ruptured. This patient had undergone surgery for the ruptured achilles and was returning to the clinic today for a post-operation appointment. It was very interesting to see the patient both before and after the surgery had occurred.

Today I was at home because of Covid-19 restrictions at Duke Hospital. I spent the day researching the uses of ankle fusions. An ankle fusion is when a plate is surgically inserted at the ankle joint and the cartilage of the joint is removed. This causes the bones involved in the joint to grow together which will no longer allow for movement in the ankle. An ankle fusion is most commonly used when there is a serve injury to the ankle joint or there is arthritis in the ankle joint. For example, I met with a patient that had a gun shot wound to the talus causing massive amounts of damage in the ankle joint. The ankle was fused to allow for the talus to heal and to stop the pain that was being caused by a damaged talus. After an ankle fusion, the patient will no longer have a wide range of motion in their foot, however, they will still be able to walk and they will no longer be in pain.

The image above shows two different ways that the ankle can be fused.

Today I was at home as Duke Hospital would not allow me in the operating room due to Covid-19 restrictions. I spent the day further researching the procedure to hold the tibia and fibula in place. This procedure is used when there is a fracture in the tibia or fibula. After this procedure, these bones will be held in place for healing.

This procedure is an ORIF surgery and the method I learned about is the Anthrex Tightrope procedure. This procedure varies due to the location of the fracture, however, there are a few similarities between each procedure. This procedure is done by first attaching a plate to the tibia or fibula. This plate will be attached by a maximum of 9 screws and will act as an anchor in the bone. Then, the surgeon will drill a hole threw the bone and the plate. A “tightrope” (a very strong wire) will be threaded through the hole and tied at the other side. This wire will anchor the tibia to the fibula and hold both bones in place.

The image above shows how the tightrope is used to hold the tibia and fibula in place.

Today I attended the Duke Orthopedic clinic once again with Dr. Schweitzer. However, today’s clinic was at the Duke Orthopedics Cary location. We spent the day meeting with patients to diagnose a current injury or to meet with the patient post-operation.

Today, I learned about the different operations to fix ankle arthritis. The first option is to fuse the ankle, stopping any motion of the ankle joint where the arthritis is located. Since the ankle joint is no longer moving, the bones in the ankle where there is a lack or cartilage will not rub against each other anymore. The second option to fix ankle arthritis is an ankle replacement. For the ankle replacement procedure, an MRI first needs to be taken to determine the strength of the bone. If the bone is strong, a smaller ankle replacement can be used. However, if the bone is weak, the ankle replacement will need to be larger and inserted much further into the bone to insure stability. Fusing the ankle will not allow for any movement in the ankle joint but is almost 100% effective and the technology has been around for many years. The ankle replacement is newer technology so doctors do not know the long term effectiveness of this surgery, however, ankle replacements are 85% effective after 10 years.

 

The image on the left shows one type of ankle replacement while the image on the right shows one way that the ankle can be fused.

Today I was at home due to Covid-19 restrictions. I spend the day researching and learning about the process of charting. Charting is when doctors take notes after meeting with each patient during clinic and put them in a program such as EPIC. These notes will address the issues discussed during the meeting, proposed treatment plans, and any comments about the patient. When the patient arrives for their next visit, the doctor will open the notes to be reminded of discussions and treatments that occurred in the past. These notes also help the doctors to better judge the progress that the patient has made.

The image above shows the EPIC program and how it can be used to take notes on each patient.

Today I began the day at 7:30 working again with Dr. Schweitzer. Today was the second day of clinic with a focus on new patients and there were 44 patients total. We spent the morning meeting with each new patient and wrote notes about each patient that could be used during future visits. I learned how to repair a tibia or fibula fracture through open surgery and visited with some patients today that underwent this procedure. These patients had post-operation appointments today.

In the afternoon, I visited with Dr. Grant, a sports medicine orthopedic surgeon. Today, the sports medicine clinic was in session and we visited with many patients throughout the afternoon. The majority of the patients that we visited with had already underwent surgery and were attending their post operation appointments to get cleared for activity.  Today I learned how a sports medicine surgeon can help a patient to recover from arthritis. This can be done by repairing the cartilage by making small cuts in the bone located underneath the cartilage.

Today I visited Duke Raleigh Orthopedics to shadow Dr. Schweitzer, a foot and ankle orthopedic surgeon. During hospital hours today, the clinic was in session. Dr. Schweitzer and I visited with many different patients with various foot and ankle related injuries. We would them give then a diagnosis and a treatment plan (surgery, physical therapy, referral, or a different treatment). We visited with more than 40 patients during todays clinic hours. Today I learned how to diagnose an Achilles tear and the treatment procedures that go with it it. I was surprised at the number of patients each doctor visited with each day. There was a team of nurses or orthopedic doctors that worked to most efficiently diagnose and treat each patient.