Source: Blog Post

Today our day was filled with challenging operative cases.  We started by picking up a patient on the way to the clinic.  Our van pulled over for a family that had taken a public bus to Siguatepeque and needed transportation to the clinic.


One of the recurring themes in underserved populations is the pediatric supracondylar humerus malunion.  Today, one of our cases was a 10 year-old boy with a 25 degree cubitus varus deformity resulting from a malunited supracondylar fracture.  Hand surgeon Apurva Shah, MD MBA and fellow Nicholas Beck, MD performed an ulnar nerve decompression and a lateral closing wedge osteotomy of the distal humerus.  An oscillating saw was used to make the osteotomy using temporary converging Kirschner wires as cutting guides.  Crossed medial and lateral Steinmann pins were used for fixation of the osteotomy, and the patient will remain in a cast for 6 weeks after surgery.  Additionally, he had a custom orthoplast splint formed by OT Meagan Pehnke in the OR which will be used following cast discontinuation.


We also took care of a 9 year-old girl with a burn contracture from 1 year ago which occurred while burning trash at her home.  This is common in Honduras since there is limited public sanitation services.  We were able to perform a contracture release with a full-thickness graft from the antecubital fossa.  She was brave and informed us her favorite color was purple.  Armed with a purple handmade-donated quilt and stuffed animal, she marched into the OR to have her surgery.  We are constantly amazed at our patients and their families here.  Parents take leap of faith in entrusting a group of visiting surgeons and nurses to take care of their child.  In recovery with her purple cast, the child was all smiles.  She will stay overnight and return to the clinic in 3 weeks where she will be transitioned to a custom-made splint to maintain her fingers in extension.


Additional cases include a post-traumatic elbow contracture release and tendon transfers for a patient with spastic hemiplegic cerebral palsy.


Operating in a developing country can at times have some challenges.  Yesterday afternoon, the air-conditioning was not functioning in one of the OR rooms.  Today we learned that the culprit was a misguided gecko.  This gecko has become trapped in the compressor and short circuited the unit.  The distal humeral osteotomy was performed in high humidity with the room temperature exceeding 80 degrees Fahrenheit.  To our relief, the unit was repaired by midday allowing completing of the tendon transfers in greater comfort.


We finished our day by making evening rounds on six inpatients.  All of the children were doing well and resting comfortably.  After a long hard day of surgery, we are off to a late dinner!


“Your life will become better by making other lives better.”  Will Smith, actor