Last week we were consulted on a 75 year old male with possible multiple myeloma. Before going over to the hospital to see him we pulled up his films to get an idea of what we were dealing with. The man had boney lesions in his humerus, spine, and femur. We were being consulted on the lesion in his femur. The femur is a large weight bearing bone so it's important that it's integrity not be compromised. A lesion will compromise that integrity which can and will most likely lead to a fracture. A femur fracture in a cancer patient would be devastating to their chances of recovery. The oncologist wanted to know if this patient was a candidate for surgery to prevent the bone from breaking. After reviewing his chart and speaking with him and his family it was determined that he would be a good candidate.

We did his surgery 2 days later. This surgery was probably the most manly/barbaric orthopedic surgery that I'd seen thus far. It was also one of the simplest. We placed a rod called a gamma nail down through the femur. Surprisingly it only took 3 incisions, 1 larger and 2 small. The gamma nail itself was as long as the man's femur. That's huge!! The patient is lying flat on their back on the table and the table is up in the air at eye level. During the procedure you basically take this gigantic rod and hammer the crap out of it until it is shoved inside the entire length of the femur. I probably shouldn't have used the word hammer to describe how we get the nail down there. It's actually a metal mallet, more like a mini sledge hammer. It's very heavy which helps with getting the rod down. The doctor was hammering with all he had for 2 straight minutes to get that thing in place. Once it is determined that the nail is at the correct length you take and place another smaller rod and put it through the hip perpendicular to the gamma nail. This holds it in place and provides extra support to the femoral neck hopefully preventing a future fracture there as well. Then you put 2 small screws across the very bottom of the rod to keep it from sliding up. It is the messiest ortho surgery that I've done. I hope I get to do that one again before I'm done!

Sorry there's no pictures. The only pictures I could find were actually surgery pictures and some of you would not appreciate those :)