Tuesday 19 May 2015

Not my story

I am very proud of the fact that the stories I tell here are true (with certain details altered for anonymity's sake, of course).  I've confessed in the past that one of them was wholly plumbed directly from the depths of my imagination, but I've also confessed that that may not, in fact, be true.  I always change names, I usually change ages, and I sometimes change genders, medical history, and certain extraneous diagnoses.

For this story, however, I have changed nothing.  Not only because I don't know any of the details, but because the story isn't mine.

I do apologise, but the story you're about to read (hopefully you've stayed with me so far) and the pictures you're about to see are stolen borrowed directly from the New England Journal of Medicine.  As much as I enjoy using only real pictures of my own patients, this one was just too damned good to pass up, and I felt the need to share it with you fine folks.

I know I discuss the Call Gods regularly, and I'm sure everyone must be sick and fucking tired of hearing about them.  But they keep rearing their ugly heads, so I feel compelled to keep sharing.  But the good news about them is that I'm not their only victim.  There are plenty of other trauma surgeons out there as well, so the Call Gods are free to take out their wrath and bestow their gifts on them too.

Like these two guys, for example.

In the interest of time, I'll dispense with the story (probably because I don't know it), except to say that it was a 33-year old man who was involved a motorcycle accident (of course it was a goddamned motorcycle) in Germany.  On initial examination his scrotum was swollen and blue (and before you ask, no, "blue balls" aren't actually blue), and though he had some other injuries (fractures of his forearm and hand), his pelvis X-ray revealed something a bit . . . surprising:

In case you can't read pelvis X-rays, the title of the article is a dead giveaway:

Femoral-Head Dislocation to the Scrotum

Wait . . . wh wh what?  Is that even remotely possible?


The blue arrow in the photo is pointing to some other pelvic fractures, but that yellow arrow is pointing to the money shot - that's the head of his femur (the thigh bone) in the patient's scrotum.  How it got there is completely beyond my limited imagination, but a CT scan confirmed the diagnosis:
I'll dispense with the obvious "boner" jokes at this point.

The gentleman was taken to surgery, and the orthopaedic surgeon went where few orthopaedic surgeons have ever dared to go before: the scrotum.  They made a direct incision into the scrotum to retrieve the femoral head . . .
. . . and then, with the assistance of some wires, plates, and screws, they put it back where it belonged:
If the pictures aren't amazing enough, the man made a full recovery and was walking without the assistance of a cane only 14 months later.

I have shown these photos to several of my orthopaedic colleagues, and they all have the same reaction I did, which is somewhere between sheer disbelief and "HOLY FUCK!".  One of them mentioned that he has never, ever made an incision in the scrotum and hopefully would never have to.  Fortunately for the motorcycle-riding population of earth, this is a once-in-a-career type of injury.

But freak injuries like this do confirm one thing: the Call Gods aren't nearly through with me yet.


  1. So how did the femoral head enter the scrotum internally? Did it have to bust through something in order to enter it? And what was the path the femoral head took to end up in the scrotum? what internal damage did the head do on the way?

    1. The femoral head must have gone through the thigh, through the groin, and into the scrotum. That's a long way for a femoral head to travel, so it was obviously a high-energy impact, and the hip must have taken the brunt of it. But according to the article, the patient incredibly had no long-term urological sequelae from the injury.

  2. ... that's enough internet for me today. ;)

  3. I can see there's a big difference between surgeons and carpenters. if a carpenter made a repair like that he'd get all sorts of flak. (yeah, I know, a big difference between a femur and a chair, too)

  4. That's gotta hurt!

    Wowzers, you must have to land pretty hard to snap the femur like that, but it was a good catch! I guess it's a lot harder to make an effective repair if the femoral head has skidded off down the autobahn!

  5. Ok, I know I don't know how to read x-rays well enough to have THAT one on my list of differential diagnoses!

  6. OMG, that has to be the strangest injury I've ever heard of!!

  7. I'm an ortho girl and I sat here looking at the photo thinking, is that a...? No...it can't be a NOF in his ballsac...and yet it was...


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