Larry Brown, Malpractice and the Mayo Clinic

First off, the Pistons should do everything they can to keep Larry Brown as coach. His value is obvious from the contrast in record this year, when he was on the bench and when not. Remember the bomb scare game against Indiana? Brown was out, the team was playing poorly, I wondered whether it was Joe Dumars who called in the bomb threat, knowing what might happen if the game were played. Indiana won by double digits. You could argue that the Piston's were pretty good with Carlisle. But Brown helped Ben Wallace to be better, and when Ben Wallace is better the Piston's won. The only reasons why management might not want Brown are bad reasons - he doesn't have to take their stuff because he could go to lots of other, easier jobs.

Brown wants to coach if he can. He was working out players for the draft.

Anyway:

"Brown missed 17 games this season because of two surgeries: first, to repair his artificial hip; second, because his bladder had swollen to four times its normal size."

Having to pee and having to hold it to half time might hurt your enjoyment of the game, and even distract you from the business at hand. Then getting to half time and not being able to whiz?

Anyway, it turns out that nerve damage, which might be the source of the bladder problem, is a common complication of this surgery. So are urinary tract infections.

Mayo clinic will be another post.


J Arthroplasty. 2004 Jun;19(4 Suppl 1):104-7.

Neurovascular injury: avoiding catastrophe.

Barrack RL.Tulane University Health Sciences Center, Department of Orthopaedic Surgery, New Orleans, Louisiana 70112, USA.

Major neurovascular injury is the least common, but most distressing, complication of total hip arthroplasty (THA). The keys to minimizing the incidence of these complications are recognizing patients at risk and knowledge of the relevant anatomy. Partial sciatic palsy is the most common nerve injury. At least partial recovery can be expected in 70% to 80% of cases, with the remainder frequently displaying dissatisfaction with their surgery. Vascular injury is most frequently associated with the use of screws for fixation of structural grafts, acetabulur components, and protrusio rings or cages. An understanding of the acetabular quadrant system is crucial in minimizing these potentially catastrophic complications.


Orthopedics. 2004 Jan;27(1):73-81; quiz 82-3.

Current overview of neurovascular structures in hip arthroplasty: anatomy, preoperative evaluation, approaches, and operative techniques to avoid complications.

Rue JP, Inoue N, Mont MA.Department of Orthopedic Surgery, The Johns Hopkins Medical Institutions Baltimore, MD, USA.

Total hip arthroplasty is a common and relatively safe procedure with consistently good results. Despite its popularity and excellent results, THA is a major operation with several major neurovascular structures within reach of retractors, scalpel blades, drills, screws, and reamers. A thorough knowledge of their anatomic location and proximity to the operative field, along with a basic understanding of the principles of vascular surgery can help avoid potentially devastating consequences. Specifically, the surgeon should avoid placement of screws in the anterior-superior quadrant, be vigilant when placing retractors, and avoid excessive tension on the sciatic nerve.