Tuesday, March 18, 2014

What no man has done before . . . in Kudjip

Femur fractures are difficult fractures to deal with in our setting of mostly nonoperative orthopedics.  Femur fractures (break of the big long bone of the upper leg) require our patients to be in a bed for about 2 months.  We put a pin - a metal nail - through the bone of their tibia (lower leg) and then attach weights to this pin in order to straighten their leg.  As the bones straighten out, it aligns the ends of the fracture and then over time it forms new bones and it heals.  The majority of our patients do fine with this and in 2-3 months they have new bone that healed over the fracture site and they walk home. 
Unfortunately, it doesn't always work in everyone.  We currently have a young man who sustained a bad fracture of his femur and the bones haven't aligned yet, despite being in traction for a few months.  This femur is in a couple pieces, so putting a rod or a plate is difficult in our setting, where we don't have an xray machine in our operating room to assist with the surgery. 
Dr. Jim asked a fellow surgeon for help and he recommended that we try to do a "bone marrow transplant."  He said to take some of the bone marrow from his hip and put it into the fracture site.  He has had success with it generating new bone growth.  We have seen the success in one of our workers, who also had a nonhealing femur fracture and had this done by this doctor and he is now walking without difficulty.  So we knew it can work, we had just never done it before. 
Jim was conveniently going on vacation, so Mark Crouch, our new doctor and Bill McCoy, our doctor who we all go to for help, agreed to give it a try.  Looking at some medical journals online, they found reports of success from India, but the fractures they were healing were significantly smaller than the huge gap they had before them.  Not letting the size of the deficit deter them, they set out to give it a try.
They used the ultrasound machine to find the ends of the bones and made marks on the skin to indicate where the needle would go to place the bone marrow on the ends of the bone.  They put the patient to sleep and then extracted the bone marrow from his hip and then using the marks on the skin, put the needles into his leg along the ends of the bone and pushed the marrow inside. 
It will take a few weeks to know if this works, but we are excited to see if it will.