Fracture

The man is lying on the twisted gurney in obvious pain. His relatives and friends stand around panting, trying to catch their breath. They've just hauled him in off the back of the pick-up where he had bounced up and down and all around on the pothole-filled dirt road from Lai.

I bend over his left leg and gently lift the blood soaked rags.

A Betadine browned compress with a bright red bloody center is all that stands between me and the fracture. I gingerly lift it up to see the bright white shard of bond sticking up from a black spider-webbed mass of sutures ineffectively attempting to hold the wound together.

It's been three days since he fell of the gravel truck.

A piece of cardboard is bent around the back and sides of the legs and tied on with string in a lame effort to stabilize the broken tibia.

"We have to operate, clean out the wound and try to get the fracture stabilized."

The family understands and willing forks over the $60 necessary for the surgery, medications, hospital stay, etc.

After knocking him out with a heavy dose of "Special K" (Ketamine) and Valium I have my sister Chelsey grab his foot and pull.

"Lean into it, let your body weight do the work, not your arms," I tell her.

Simeon is at the head of the gurney. We are in the OR prep room with a pulse oximeter attached to monitor our anesthetized patient. Simeon has also given the antibiotics.

Meanwhile, i prepare a 5 liter basin of diluted bleach solution and open up a tray of sterile instruments. The procedure is not sterile as the sand and gravel inside the wound testify, but I guess sterile-to-start-with instruments isn't a bad idea.

I cut all the old sutures and bend the foot down and back so the bone fragment sticks out more allowing me to put my finger behind the bone and with the help of a bulb syringe start to wash out the debris.

After five liters, the wound is fairly clean. I cut off any dead looking tissue and then try and reduce the fracture. A huge posterior piece of the bone is not there, probably removed in Lai, meaning the bone is trying to balance itself on the half centimenter anterior segment. It doesn't work very well but with Simeon now pulling and Chelsey putting medial pressure on the lower segment and lateral pressure on the upper segment it stays pretty well.

Then I have to try and close a gaping 10 cm wound. I use heavy suture with special mattress type sutures and little by little it mostly closes but under a lot of tension. Who knows if it'll hold up, but it's the best I can do.

Then, I pull out an external hard plastic shell for lower leg fractures I picked up last year at my old haunt in Ventura County, California and strap it around the leg to stabilize the fracture.

Amazingly, three days later, the wound is still holding together with no signs of infection and the fracture is more or less still in a good orientation to heal. Maybe a miracle will happen again...