18WillN – CA Work Experience Program

Day 8

What a last day! I had a great time working with Dr. Huff during the past few weeks, and it has been an excellent experience.

Today consisted of three surgeries, two of which I had never seen before. The first surgery was a ACL reconstruction. During the procedure, Dr. Huff took a graph from the patella tendon and inserted the graph to where the ACL should be anatomically. I enjoyed watching this procedure because it tied all aspects of the two weeks together as knee scoping and joint repair were both used during this operation. At the beginning of the operation, a graph was cut from the patella tendon. The reason for using the patella tendon is because it was the closest compromise to the ACL when compared to a hamstring graph. The graph was then trimmed to fit inside of a certain diameter hole. Before putting the graph into the knee, Dr. Huff used a drill to create two holes, one in the femur and one in the tibia. The reason for using holes to secure the graph was because there would be more surface area resulting in a stronger and more successful recovery. After the holes were created, the graph was inserted and the knee was then scoped to make sure everything looked okay.

The second surgery was a carpal tunnel release which consisted of Dr. Huff using tools to cut a nerve within the palm of the hand. By doing so, he would take away the numb sensation associated with carpal tunnel syndrome.

My final surgery was similar to the carpal tunnel release as it was short, but it was something that I had never seen before. It was a operation that fixed a “trigger thumb”. This occurs when the sheath of the tendon becomes stiff which then reduces dexterity. Dr. Huff relieved the patient of the symptoms by cutting part of the flexor tendon sheath. This then allowed for the tendon to slide smoothly instead of having resistance from the sheath. With time, the sheath will heal and will then be the right size for optimal tendon movement.

After eating lunch with Dr. Huff, we concluded the day by seeing patients. Today, there was a very wide variety of patients that we visited. Every patient had a different background and story which is what made each visit unique and interesting.

I would like to thank Dr. Huff and his partners again for having me these past two weeks. I had a fantastic time!

Day 7

Today was an excellent day at Huff Orthopedics. After meeting in the parking lot of the hospital, we made our way to the locker room as usual. In regards to the surgeries, Dr. Huff completed another rotator cuff repair, a knee scope and a bursa mass resection on the elbow.

In the first surgery, the rotator cuff repair, Dr. Huff used the shoulder scope device to move around inside of the shoulder joint. He then used a suture along with anchors to secure the tear in the cuff for recovery.
The second surgery consisted of a meniscus repair on the knee joint. In the surgery, Dr. Huff used the knee scope devices. These devices are very similar to the shoulder scoping equipment. It was amazing to me because this surgery only lasted ten minutes.

The final surgery consisted of Dr. Huff using a scalpel to cut a bursa mass from the elbow. This mass was most likely from a fall when the patient hit their elbow in the past. The surgery was fairly simple, Dr. Huff cut into the skin to reach the mass which he then cut out. However, he had to be especially careful for hitting a nerve which controls the hand.

To wrap up the day, Dr. Huff and I met with many patients at his office. Overall, I have had a fantastic week, and I look forward to my final day at the office!

Day 6

Day six was much shorter than the rest of the days in regards to surgery. With the 7:00 meet time along with only two quick surgeries, Dr. Huff and I were meeting with patients outside of the operating room by 10:30.

The first surgery consisted of a knee scope along with a patella (kneecap) repair. In the scope portion of the surgery, Dr. Huff cleaned out the knee joint by using clippers. By doing so, he relieved the patient of some of her pain. However, the main part of the surgery which was very interesting was when he relocated the patella. During this time, Dr. Huff cut an incision above the patella. He then tied a suture to the patella which was then tied to a portion of tissue above and to the right of the patella. As a result, Dr. Huff fully relocated the patella into its correct location. The reason for this surgery was because the patient had arthritis along the patella and fibia due to the initial placement of the patella. By relocating the patella, Dr. Huff took away the arthritis pains because there was no more bone on bone contact. Again, like I mentioned before in my previous posts, many of procedures of these surgeries are easy to understand if you use your head to figure out the problem. While the surgery is complex, the goal is often times fairly simple.

The second surgery was another knee scope. Similar to the first operation, this one only lasted about 40 minutes. Like the previous knee scopes I’ve seen, this one also involved Dr. Huff cleaning the knee joint out of torn tissue within the joint.

After about 10:30, Dr. Huff and I made our way over to his office. At around 12:00, we then met with a mentor/friend of Dr. Huff. The mentor was also a orthopedic surgeon who Dr. Huff had shadowed when he was a teenager. It was very interesting for me to see this as it showed me the cycle of interests. I learned that it just takes an initial spark of interesting and passion to fully engage somebody into pursuing a career path that they love.

Following lunch, Dr. Huff and I met with more patients. It was fun to meet all of the different patients and see their own unique cases. Even though today was one of the slower days, it was still action packed, and I had a blast! I’m looking forward to tomorrow!

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– Patella displacement

Day 5 Update

The beginning to the new week of my internship with Dr. Huff started out great! After meeting at 7:00 and changing into our scrubs, we made our way into the operating room for the first case.

In the first procedure of the day, Dr. Huff had to repair a rotator cuff. In the operation, Dr. Huff used a scope with camera along with a variety of tools to help cut, snip, and trim any tissue needed to complete the procedure. All of the procedure was done through two small incisions in the patient’s shoulder. After locating the tear within the shoulder joint, Dr. Huff used a suture to mark the tear from below the rotator cuff so he could find it later in the procedure. After doing so, he then moved above the rotator cuff to repair the tear. To repair the shoulder, Dr. Huff used a bur, similar to a grinder, to trim away the bone spur inside the joint. If he was to skip this step, then the bone spur would cause the muscles to tear again. After he took away the spur, he then used a suture to tie the tear together. Along with the sutures, he also used biodegradable anchors to securely fasten the sutures into the muscle tissue. These anchors would dissolve after about a year.

Another interesting procedure from today was fixing a Stener lesion which is also known as “gamekeepers thumb”. Stener lesions are caused due to repeated stress. Because of the stress, the ligament that had originally connected the metacarpal, the first thumb bone, and trapezium, the thumb knuckle, was torn. To fix the ligament, Dr Huff drilled two pins into the metacarpal. He then tied the suture to the ligament and to the end of both pins. Following this, Dr Huff pulled the pins through the metacarpal bone which threaded the suture through the metacarpal. The suture was then tied on the lateral side of the metacarpal, so the ligament sat firmly against the medial side of the metacarpal. During recovery, the ligament would heal and develop tissue to secure itself against the metacarpal. Then the stitches would be able to be removed.

After talking about hunting, fishing and summer plans in the break room, we entered our final surgery of the day. This surgery was very quick. The patient had a MRSA infection which had caused a fluid buildup in the elbow and wrist. During the operation, Dr. Huff drained the fluid by making a small incision.

To cap off the day, we walked over to his office after a quick lunch break. We then met with patients. Again, like I have mentioned before, I particularly like this part of the day because it has allowed me to see the personal relationship between the doctor and patient. Today was another great day working with Dr. Huff and I look forward to another exciting day tomorrow!

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Rotator cuff repair

Day 4 – Huff Ortho

Today was slightly different from the previous three days of the week. Since Dr. Huff does not go to the office or have any surgeries on Fridays, I did not go to the hospital today. Instead, I researched a number of cases that I had seen in the previous week from home. In my research, I looked into cases that I was curious about. Two of these cases were Osteochondritis dissecans and Stener Lesions.

Stener lesions, also known as “gamekeepers thumb”, originated from Scottish hunters who had developed thumb problems. Due to humanely dispatching their harvest, they would put pressure on their MCP joint. This would then cause stress to the ligament within that joint causing a tear. As a result, the ligament would then lay on top of the thumb bone and not within the joint. With the ligament attached to the bone further behind than needed, the thumb then would develop a sway away from the other fingers instead of remaining parallel with them. This sway is one of the biggest indicators of a Stener lesion for a doctor. In regards to treatment, there is virtually no way to fix a Stener lesion without surgery. During the surgery, the doctor would break the ligament away from the place at which it rested during the lesion. Then, the doctor would attach the ligament on the MCP joint where it would be anatomically correct.

Another case that I found particularly interesting this week was Osteochondritis Dissicans (OD). This case appears when there has been a trauma lesion to the knee joint. When the lesion forms, a portion of the bone within the knee socket, whether it be the tibia or femur, breaks loose due to pressure. This broken part of the bone then rests inside of the joint until surgery. As a result, the patient is then under a tremendous amount of pain since there is loose bone inside of their knee joint, and there is also an area of exposed bone without cartilage around it. Osteochondritis Dissicans is actually fairly rare, and it mainly affects adolescents because they are more prone to having growing pains rather than adults. In regards to treatment, surgery is the main option. During the week, I had the opportunity to witness a surgery in order to fix the OD. The main goal of the surgery was to locate the missing piece of bone tissue and then place it back onto the lesion using darts. These darts were made of plastic and had barbs on them so that they would stay in place after the surgery during the healing process. However, the surgery is much more difficult than it sounds. With a great deal of perseverance, Dr. Huff located the piece of bone and took it out of the knee through a small incision. To compensate for the missing piece of bone, he then drilled holes into the lesion. These holes went all the way to the bone marrow. The result of the bone marrow cells entering the lesion is that new bone would then form around the lesion to recreate the bone.

Overall, I had a great week with Dr. Huff, and I can’t wait for next week!

Day 3 Update – Huff Orthopedics

Day three was fantastic! Like day one and two we met bright and early in front of the hospital to then change into our scrubs. Today was filled with many highlights and memorable moments!

The first two procedures that were conducted were knee scopes. Like I have mentioned in previous blogs before, the knee scopes are done instead of an actual replacement if possible. This is because the recovery time for a knee scope is much less than for a full replacement. However, the second knee scope was particularly interesting. In this case, there was a lesion, or a missing piece of bone, due to impact trauma on the femur. As a result, the patient was limping and in a great deal of pain. To help, Dr. Huff used his camera and variety of tools to find the lesion. After a great deal of perseverance, Dr. Huff finally found the lesion inside of the knee joint. While it was a success to actually find the separate piece of bone in the joint, there was no way for Dr. Huff to successfully attach the piece of bone to the femur. So, to compensate, Dr. Huff drilled holes into the femur in the location of the lesion. The holes went all the way to the marrow. Since he went to the marrow, the marrow would then be able to create new bone tissue around the lesion and successfully heal.

Another interesting procedure done today was on an ankle fracture. Since the fracture could not be healed from wearing a boot, a plate and screws were necessary for the operation. In the operation, Dr. Huff drilled a guide wire into the ankle of the patient. He then used the guide wire, to help direct the screws into a proper position. The reason why I have found the past surgeries to be so intriguing is because of how simple the concept is. If you actually, use your brain and think about what the main goal of the surgery is, then you will be able to figure out the main steps needed to complete the surgery. Sure, this is much easier said than done, but I do believe that it is very beneficial to have an outline of the surgery in your mind.

To wrap up the day, Dr. Huff and I went to his office across the street like on Day 1 and 2. We then met with a variety of patients with a mix of needs. Another reason why I have found Dr. Huff’s orthopedic practice to be fascinating is because of the variety of patients and cases that he sees. Since he is the only doctor in his practice and covers all of Sampson and two of the surrounding counties, he has a constant flow of cases. He sees everything which is what makes his job so interesting. The surgeries on Day 1 were completely different than the surgeries done today.

It was a great week shadowing Dr. Huff, and I am already looking forward to what lies in the schedule for next week!

Day 2 Update

Day two started similarly to day one. At the beginning of the day, Dr. Huff and I met in the parking lot in front of his office. From there, we walked across the street to enter the main hospital building. We then went into the locker room to change into our scrubs.

In his first procedure, Dr. Huff had to repair a rotator cuff. During the operation, Dr. Huff used a variety of tools, along with his small camera, to help probe and repair the fractured tissue within the shoulder joint. Some of the tools included clippers and grinders. The clippers were used to snip the fractured tissue away from the actual rotator cuff. The grinder was used to remove a bone spur inside of the shoulder joint.

In his second procedure, Dr. Huff amputated the radial part of an index finger. The reason for the amputation was because the current condition that the finger was in was more of a bother to the patient rather than an aid. Since there was no dexterity in the stump of the index finger, it would just get hung up on objects when the patient was working. So, it only made sense to remove the small portion of the index finger.

In his final procedure of the day, Dr. Huff replaced a hip joint. To me, this operation was very interesting. Similarly to the knee joint, the concept was very simple; however, the actual work and procedure involved was complex. During the surgery, Dr. Huff removed the ball joint in the hip which was fractured. He then sized the different joint replacements accordingly to the right size of the hip. After he found the right size, he placed the ball inside of the hip. He then hammered to securing devices into the femur. The supports connected the actual femur to the replacement joint which was placed in the socket of the hip.

To finish off the day, Dr. Huff and I met with some of his patients in his office. We looked over the progress that they had made since their surgeries and what the plan was moving forward. Again, I particularly liked this portion of he day because I was able to see Dr. Huff interact with the patients he had recently helped. After making his rounds, we then traveled to the Lakewood High School to do sport physicals on students. This was program that Dr. Huff had initiated himself. He would contact local high schools and ask if he could do sports physicals on the students. Not only did this prevent any complications during the seasons with scheduling a physical, but Dr. Huff also helped raise money for the school athletic department. Each student was required to pay $10 in order to have a physical. Instead of keeping the money, Dr. Huff wrote a check back to the athletic department so that they could have funding for new equipment. To me, this was a creative and compassionate way to give back to the local community. Overall, day to was awesome and I am looking forward to another exciting day tomorrow!

Day 1 – Huff Orthopedics

Today was amazing! I had the opportunity to witness numerous operations that I have never been able to see. From knee replacements to knee scopes, I saw many types of procedures in the orthopedic field.

To begin my internship, I traveled to Clinton, NC. At 7:00 this morning, I met Dr. Huff at the Sampson Regional Medical Center. We then dressed i nto our scrubs and entered the operating room. Our first procedure was a knee replacement. The purpose of a knee replacement is to reduce the pain from bone on bone arthritis in the knee joint. There are even different sizes of knee replacements so the new knee joint will fit the current bone structure of the previous knee. While the tools that were used in the surgery were intense, the actual surgery was very intricate. All of the fittings were precise with no compromises. Multiple times, irrigation was used in order to prevent the chance of infection from the replacement. To reduce tension in the operating room, Dr. Huff even played music on a speaker that he had.

After our second knee replacement, we proceeded to do a knee scope. In this procedure, Dr. Huff used a camera to enter the knee joint. When he could see the knee with his camera, he then used multiple tools to take inflamed tissue from the joint. By removing the tissue from the knee joint, Dr. Huff delayed the amount of time until the patient would need to have a knee replacement.

Following our quick lunch break, I shadowed Dr. Huff as he repaired a fractured patella, or kneecap. In the operation, he used a wire to tie the two parts of the patella together so they could heal. After the operation, we then went to his office to do patient consults. This was particularly interesting because I had never been on the medical side of being a patient. At this time of the day, I was able to see the human aspect of the medical profession. After the surgeries, it was nice to finally interact with the patients.

Overall, I had an excellent first day, and I could not thank Dr. Huff more for allowing me to shadow his work. As of now, I’m looking forward to another bright and early start for tomorrow!