broken fingers

[c diddy]

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okay, maybe not broken, but let's say jammed or injured in some way. i am an ms2 and have a quick question for the surgeons. i am very into sports (mainly wrestling and basketball) and i routinely injure either a finger, ankle, elbow, etc. while playing. i apologize if this question seems silly, but how significantly wound an injured or poorly mobile finger joint(s) affect a surgeon's abilities in the or? would certain types of procedures or surgical fields be more strongly influenced by such a handicap than others? i have zero experience in the or thus far, which is why i ask. thanks very much for any thoughts.

 

[tussy]

It is a huge deal. One of our gen surg PGY1 this year fell and suffered a scaphoid fracture (12 weeks in a cast). It was a scheduling nightmare. He was lucky in that he was able to juggle is schedule and do his non-surgical rotations while he was in a cast. Had he been further ahead in his residency he would have had to go off on disability or do a pathology or research elective.

I sprained my wrist a few months ago, and my staffman made me scrub despite the pain in my wrist. Luckily i had a clerk on the service who became my own personal retractor holder (he got a great evaluation for his enthusiasm and willingness to do some of my scut). The potential for hand/arm injury becomes more and more scary, and most surgical residents stop doing those high risk activities that could lead to injuries.

 

[droliver]

One of my chief residents when i was a pgy-2 got thrown off his girlfriends horse & suffered bilateral distal radial fractures. He couldn't work for about 10 weeks

 

[LaCirujana]

One of my attendings this month (neurosurg. rotation) jammed his right middle finger this week. He had a hard splint autoclaved between cases, scrubbed, applied the splint, and then gloved. He operated for 2 days like that. I guess it worked OK.

 

[triathlete411]

Speaking of autoclaving the splint - one of my attendings does not take his wedding ring off when he scrubs and gloves. It looks like he couldn't get it off if he wanted to, but I was wondering how common this practice is and how ethical it is?

 

[droliver]

triathlete411,

that's a pretty clear cut & widely-recognized breach of sterile technique. Seems kind of flip (I don't know you'd call it unethical) to do it unless you're doing cutaneous procedures

 

[girlwithaknife]

How big of a deal are such "breaches of sterile technique" these days, when you recognize that the water you scrub with is unsterile?

 

[Celiac Plexus]

Did an ENT rotation and one of the attendings made the remark that "scrubbing is all voodoo anyway"... Made me wonder what he meant. Though I guess the main barriers are the gown and the gloves.

 

[Docgeorge]

I've recently been diagnosed with Psoriasis on my hands. The thing is, it's only noticeable when I have my hands in water for any length of time, ie in the shower. Do you guys think that this will prevent me scrubbing in?

 

[triathlete411]

I was assisting on a perineal abscess I & D and the attending said to me, "Let's go scrub." I followed him into the sink area and then right back out of the sink area without ever washing my hands. He said the area in question was dirtier than anything on our hands.

I have also done burn cases where scrubbing and sterile technique is nonexistent.

As far as psoriasis on your hands, I really don't know the implications on sterile technique. I know that some surgeons are very concerned about having any open wounds on the hands - they have some special cover (like tegaderm) that they put on their papercuts, etc.

 

[droliver]

triathlete,

Perirectal I&d's really don't require sterile technique - as you point out, what are you going to do?, infect the infection. An important concept there is that you are draining something externally rather then making a closed wound.

The burn wound on the other hand is a different animal. Contamination of the wound easily leads to invasive infections & is one of the 2 principal causes of graft loss (inadequate excision being the other). The percularities of these wounds is reflected in the extensive use of topical antibiotics & rigorous anti-septic policies in most burn-units that aren't routinely done with other kinds of wounds. If you're merely doing an excision of eschar in the OR (vs. excision & grafting or grafting after previous excision) you could prob. be a little less anal about things (no pun intended) as that is essentially a fancy dressing change.