Orthopedic care after a catastrophe

This boy was able to hobble out of the clinic without the cast he had been wearing for almost two months.
This boy was able to hobble out of the clinic without the cast he wore for two months.

Although there’s long been a need for improved orthopedic care in Haiti, the nature of the trauma injuries caused by the earthquake has exacerbated the problem into a dire one. Currently, there are only 15 Haitian orthopedists working in the country. “Because of all the associated bone injuries,  which require x-rays, cast changes and ongoing surgeries, it’s clear there’s a chronic need for orthopedic care here,” says George Dyer, staff orthopedic surgeon at Children’s. “That one earthquake created work for a generation of orthopedic surgeons.”

Walking around the hospital, there’s no end to the number of people in casts and external fixation devices–metal rods or pins attached outside of the body to keep a bone in place. “After the earthquake there were so many people with broken femurs that the only thing that could be done was place external fixators on their legs, which can be done quickly and without x-ray,” says Paul Appleton, orthopaedic trauma surgeon at BIDMC. “Some people got casts, but if they had a severe injury to the skin over the bone, the wounds couldn’t be covered due to the need for daily dressing changes.”

Many of the external fixation devices were put on immediately after the earthquake by visiting medical teams all over the country. But now, two months later a new challenge has emerged: how to remove them.

At the outpatient clinic in Cange, a group of people with a variety of casts and external fixation devices sat around, each clutching their own personal x-ray, waiting to have it read. Patients had traveled from near and far to see if their bones had healed.The x-ray machine was out of order for a few hours, but once it was back up and running, Appleton spent time scrutinizing each image and talking to the patients through a translator. Without any patient medical records, Appleton had to piece together what had already been done and come up with a future treatment plan.

While many patient’s bones had healed improperly or were infected, others were relieved when Appleton told them their casts or external fixators were ready to come off. “Many cast were covered in dirt because of the poor living conditions, so it was always a bit of a surprise as to what would be under the cast when it was removed,” says Appleton. “In several cases, flies came out.”