It seems that during our training as physicians, certain things are stressed as true and important. I'm sure that this remains true in most of the United States. But there are times when these truths are bent. I remember learning that an open fracture is considered an important thing. Something that should be fixed and cared for immediately. Here in South Sudan, and I'm sure other places around the globe, open fractures are just another bump in the road.
I was just asked to see a six year old boy who broke his leg almost a month ago. He came from another MSF site where there were no surgical capabilities. When he arrived we did a quick assessment. There in the middle of his leg, sticking out of the skin, was a ragged bone. His tibia! He has been limping around on an open fracture of his tibia for nearly a month. Some emergency, I thought. So much for all that secret orthopedic knowledge. What I was lacking was the experience in treating open fractures where the bone is sticking out of the skin, and has been for weeks, and the bone left inside the skin has started to heal. So once again, we did our best. I took him to the OT where I opened the wound a little bit, and cut out the bone that was sticking out. Then we packed his wound, and made him a type of splint that would allow for further dressing changes, yet give him support so that he can maintain some mobility. I doubt that he will ever run in the Olympics, but then again, how many of us with normal leg bones really have?
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