The title of this post has very little to do with the topic, and a lot to do with my love of Disney movies . . . but I digress.
My least favourite surgery is pretty much the exact opposite of one of my most favourite: amputation. It’s not that I don’t want to be able to allow an animal to keep all 4 of its legs. . . but I really don’t like orthopaedics. Specifically, I dislike repairing fractures. I find it frustrating. It can be incredibly rewarding, but very rarely do the two feelings balance out in the favour of rewarding.
Now, we don’t do a lot of fracture repair at my clinic. It can be tricky, finicky business. We try to stick to simple fractures. Anything overly complicated we insist on referring to an actual board certified surgeon. I actually offer referral to all fractures, because the surgeons who do nothing but surgery and have all the fancy equipment are probably going to do a better job. However, sometimes we can offer an alternative to getting your pet off The Rock, and some people appreciate this. Some people need this.
A lot of the fracture repairs we do involve plating. A metal plate with holes in it is screwed into the bone spanning across the fracture. I don’t do this. I will assist my boss when he does this, and that is where I draw the line. I have no interest in doing this. It seems so aggravating – picking the right plate, the right screws, getting the fracture reduced (aka putting the bone back together) and keeping it that way while you DRILL HOLES IN THE BONE (this would be on the list of things that give me the heebie jeebies). When I’m the one holding the broken bone in place for drilling, I’m afraid the drill is going to drill into me. I pick that over worrying about drilling the hole in the right spot.
Once the holes are made you screw in your screws, all the while hoping that you end up with a securely fastened plate that is holding the bone perfectly back together. Then you close it up and take a radiograph to make sure you screw placement is good. Are any too long? Too short? Do you have to mutter a bunch of curse words and go back in and replace some with different sizes?
Sounds like fun, eh? Yeah, not for me.
The other kind of repair we can do is to place a pin through the centre of the bone, and then put some wires around the spot where it’s broken to offer further support. This, I half don’t mind, actually. . . which is why recently, when my colleague had a cat with a simple spiral fracture in the femur and I said, “That just needs an IM pin and some cerclage wires, we can fix that here.” And she said, “You could do it! Would you do it?” I thought for a moment and shrugged and said, “Sure.”
And so December, 2011, I was lead surgeon on a fracture repair for the first time. We had a lot of fun doing it. The pin placement went really, really well. . . I got it placed, we did a quick close, and took a radiograph to double check the placement before putting the wires in. I don’t mind saying: IT WAS PERFECT. I couldn’t have possibly done it any better. I was super pumped.
Then we went back in to place the cerclage wires. I. Hate. Cerclage. Wires. By the time I had the wires placed, I wanted to stab someone in the eye with the wire cutters. Two became loose before I was done and had to be replaced. I couldn’t get the knots to lay flat. All the positive feelings from how well the IM pinning went disappeared. Poof. I was swearing, cussing, and threatening to poke wire cutters into people’s eyeballs.
There was still some satisfaction when I looked at the post-op radiographs . . . as long as I looked at the view where I couldn’t see the not flat knots. It is nice to know something was broken and not useable, and I made it better. Fingers crossed the cat does well. We’re feeling pretty confident – put 2 cat bones in a room, walk away, and when you come back you’ll have a whole cat! However, I am worried about those wire knots that aren’t flat . . . once her bones are well healed, we can take the wires out if they cause a problem, but that would probably be almost as much fun as putting them in there in the first place.
I guess you could say that under the right circumstances I enjoy fracture repair . . . I enjoy surgery as a general rule, and I like making broken animals better. For the most part, though, it’s at the very bottom of the list for surgeries I want to do in my week.