Sam’s Blog – A Final year medical student elective in Aix en Provence. Week 6 – broken bones

This week I have seen a few orthopaedic patients I will never forget, both in the department and whilst with SMUR.

The first patient was a ten-year-old boy with maladie des os de verres (not maladie des os de verts as I first thought when I heard it…). All I understood from this was that it sounded like patients with this condition had glass bones. We had been called to his school where he had a suspected fracture. I couldn’t think of the English equivalent for quite some time, after what seemed like a game of 20 questions (and some help from the doctor I was with) I managed to work out that sometimes patients with this condition get blue sclera and that it was osteogenesis imperfecta (collagen type I deficiency). This patient had been running around during his break and had a suspected fractured femur. When we arrived he was sat in a chair with the hurt leg bent 90 degrees at the knee, unable to move due to the pain and also very unsettled. His mum was already there and explained that this had had many fractures previously. Despite quite a concoction of painkillers and entonox he was still very unsettled, so he was given a small dose of ketamine to enable us to transfer him to the stretcher and straighten his leg, all of which he stayed sound asleep for! He started to wake up in the ambulance on the way to the hospital, but was quite a bit calmer.

I also spent some time in filère courte this week (minors), and amongst all the twisted ankles there was a 13-year-old girl who presented with pain in most of her right leg and general malaise for 1 week. She also had a temperature. A series of X-rays were ordered to see if there was anything going on at with her leg. When looking through the X-rays the intern and myself managed to convince ourselves that there was a very distinct mass or tumour at the level of the insertion of the patella tendon. We decided it would be best to get a radiologist’s opinion, this wasn’t a long conversation and essentially ended in the radiologist playfully laughing down the phone at our interpretation of normal radiological findings at that age. I’m pretty glad we were wrong. She was transferred to paediatrics to further investigate the cause of her temperature and malaise.

As far as the language goes I think I have improved a huge amount – both in terms of understanding and ability to talk, some of the patients hard of hearing still struggle with my terrible English accent, so there’s still room for improvement. I still have an irrational fear of answering phones though, I find understanding so much harder over the phone – I think I rely quite a lot on watching peoples mouths/faces move when they are talking, something I need to work on.  It’s absolutely crazy how quickly my time here has gone, I’ve been here 6 weeks and only 2 weeks left now. Apart from the medicine I was able to go on a little trip to the Verdon Gorge – absolutely stunning!