My 10th rotation (of 12 total) consisted of a mixture of trauma surgery and orthopaedic trauma surgery. During our PA school clinical rotations at the University of Kentucky, we get the opportunity to pursue two separate "elective" rotations in fields we are interested in. I spent the first two weeks of the rotation with the trauma surgery team and the second two weeks with the orthopaedic trauma surgery team. I chose these fields due to my background and future interest in orthopaedics, specifically in a trauma setting. I got to be part of both of these teams at a level one trauma center.
While both fields are related to trauma, they manage very different aspects of the patient. Trauma surgery is a sub-specialty of general surgery while orthopaedic trauma surgery is a sub-specialty of orthopaedics. A trauma surgeon and team manages extensive damage to various body tissues and organ systems while the orthopaedic trauma surgeon and team manages the bones, joints, ligaments and tendons related to the trauma. The trauma team typically consults with the orthopaedic team to manage related musculoskeletal injuries.
As a part of the trauma surgery team, I was a member of morning conference at 5:45am where we discussed any patients that came during the overnight shift. We then broke into our teams (A, B, C, ICU) and rounded on our patients to see what needed to be done throughout the day. I was assigned two or three patients each day and was responsible for their care, including notes, orders, consults, and a member of the operating team if necessary. I then presented the patients to my preceptor along with my assessment and plan. Days were typically 12 hours, with 3-day weeks.
Some interesting things I got to see/do with the trauma surgery team:
- I was able to participate in a "trauma alert red" (highest level trauma at our facility) where the patient coded. I was 2nd in line to perform chest compressions, and the patient was able to achieve ROSC rather quickly. Their FAST exam was negative and the patient was stable on mechanical ventilation.
- I saw a patient follow-up at the clinic s/p surgical debridement from Fournier's gangrene secondary to a perirectal abscess. This was his first follow up and he had extensive skin debridement including portions of his penis and the removal of his entire scrotum... I was not part of his surgery, but that does NOT sound fun.
I then spent some time with the orthopaedic trauma surgery team which consisted of the operating room three days per week and one day of outpatient clinic. The surgical team consisted of the attending physician, a fellow, and myself. We would arrive around 6:00am to round on patients we consult with. We would then visit pre-op to visit the patient as they prepared for surgery. We then performed the required orthopaedic surgery, and visited with the patient and family post-op once the patient was conscious after sedation wore off. Days ranged from 10 hours to 14 hours, 4 days per week.
Some interesting things I got to see/do with the orthopaedic trauma surgery team:
- A patient presented with a fractured humerus due to an MVC. Upon opening her arm for ORIF plate-fixation, we saw what looked to be cancerous bone. We sent samples to pathology, and her fracture was a result of a weakened humerus due to adenocarcinoma that metastasized from her lung.
- I got to use the mallet and adjust an intermedullary nail. I didn't get to actually hammer in the nail, I simply made some minor adjustments to ensure proper placement. However, that still took some good whacks. Orthopaedics is like wood-working... power drills, screws, nails, plates, it's such a unique and precise surgical field!
If you have any interest in orthopaedics, I LOVED this resource: https://www.orthobullets.com/
POP QUIZ ANSWER: The superficial peroneal nerve, located just anterior to the lateral malleolus. If dissected, you would lose sensation to the dorsum of the foot. You would NOT lose and eversion due to being past the point of muscular innervation.
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