One day in orthopedics.

Let's go through a case shall we? Why?! I don't know I just despise orthopedics somehow. But it's so influential.

So, my patient was a 6 year-old Malay boy came for an elective surgical operation of his right leg. At the age of 18 months his mother noticed that he limped every time he walked. She also notice that his right leg is longer and bigger than the left. But he still can walk and run. The right leg keeps getting bigger and longer. The inequalities became more obvious as he grow up. But no loss of function still. When they went to see a doctor he was diagnosed to have left leg hypertrophy. He was suggested for surgery.

The hypertrophy was secondary to neurofibromatosis, type 1. He has multiple cafe-au-lait around his body. On further history his mother also has neurofibromatosis because she has multiple fibromas around her body (NF is autosomal dominant). He has a pelxiform type of neurofibroma.



This is how it looks like.
See. It is longer and bigger.
Apparent length difference : 5 cm
True length difference : 3.5 cm
The discrepancy was only below knee.
Femur not affected.






There were some discolorations at the posterior part.
I'm not sure if this is cafe-au-lait.
But I didn't take any pictures of other cafe-au-lait at his abdomen.














The x-ray of both lower leg.
The right tibia was also bigger and longer.












This was during the surgery.
The surgeon inserted two 8-plate at the right proximal tibia to arrest the bone growth.
An epiphysiodesis.
For right tibia shortening because discrepancy more than 3 cm.














This was after the plate insertion was done.
See, the plate was put from epiphysis to metaphysis.
We must avoid physis injury because he's a growing child.
The plates are temporary.











Anyway, I presented the case to Mr. Shuk afterward but I was so bad that I don't desrerve his signature. Oh yeah.

Seeing is believing?

People are so naive aren't they. That includes me. It's even disturbing sometimes how superficial human can be. So easy to manipulate, so easy to be manipulated.

What you see is not always the truth. We assume, that's the easy way. Well that's the only way. No one can read minds. That's why people always say things like 'She looks like a nice person'. Huh.

They say the eyes can only see what the mind can see. Something like that. We only believe things that are in front of us. If I hide a fact about myself, others might even think that it doesn't even exist. It's so easy. For all you know I can even have an entirely different life out there.

I guess that is why people keep secrets. Not telling is almost as equal as non existent. People do all sorts of weird stuff in this world and they kept it a secret and the world will also think that there are no such things. Everybody wins.

But a well kept secret is better than a partial truth. People are scared of things they don't understand. Fear of the unknown. However that's an entirely different thing.