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    ICJR CASES: What’s the Case that Keep You Up at Night?

    Every surgeon has at least 1 case that they can never forget:

    The patient who is on your schedule nearly every week with a complication that just won’t resolve, no matter what you do.

    The patient who has been doing well for years, until an out-of-the-blue complication compromises the progress they’ve made.

    The patient who has healed perfectly according to radiographs but who is suffering more pain and dysfunction than before surgery, with no explainable cause.

    Sometimes, the only thing the surgeon can do is to share the case with colleagues as a teaching moment/lesson learned or as an opportunity to solicit opinions on possible next steps.

    That was the basis of the session, Worst Case of My Career: What Went Wrong and What I Did, during ICJR’s 4-part virtual CME series, ICJR Insights: Advanced Concepts® in Shoulder Surgery. Six surgeons shared challenging, gut-wrenching, heart-breaking cases that prompted a participant to say, “This has been the most genuine difficult case panel I have ever seen. So educational and sobering.”

    No case was more sobering than the 10-year (and counting) odyssey Sumant “Butch” Krishnan, MD, has been on with a female patient who was 18 years old at the time of her injury.

    The patient’s father had gifted her skydiving lessons for her 18th birthday, but she had been too scared to jump. Once the plane landed, she wanted to get out as quickly as possible. In the process, she tripped and fell out of the plane, landing on the propeller. She was taken to a trauma center with a near forequarter amputation.

    After treatment at the trauma center – which included open reduction and internal fixation of the clavicle, glenoid, and proximal humerus, as well as surgery to repair vascular and nerve injuries and debride a severe infection – the patient was referred to Dr. Krishnan with a chronic wound infection, soft tissue loss, proximal humerus bone loss, and glenoid bone loss.

    Click the image above to hear more about this case from Dr. Krishnan.

    If nothing else, this session reinforced that, “surgery can be humbling,” as another participant said, “and we should all approach what we do with humility.

    “And we all can rest assured that everyone has complications.”