Polite Dissent

Nightwing #148 “The Great Leap, part 2″
Peter J. Tomasi, writer
Rags Morales, penciler

After being shot with a bullet in the right shoulder, Nightwing makes it to the Batcave where Alfred performs arthroscopic surgery to remove the bullet fragments.

Arthroscopic Surgery (also called arthroscopy) is a type of joint surgery which uses a special fiberoptic scope that allows the surgeon to explore and repair the injured joint while minimizing the trauma from the surgery itself. The scope is attached to a camera and the surgeon follows the action on a video screen. Arthroscopy can be used on a variety of joints (shoulder, knee, spine, etc.) and for a variety of procedures — in this case, removal of a foreign body.

A small incision is made for the arthroscope and another small incision is made for any additional instruments (a blunt probe is commonly used; A pair of forceps to remove the bullet is used here). The surgeon watches the video screen as he manipulates the arthroscope and other instruments. The joint is explored, bullet fragments are found and then removed. The instruments are then withdrawn and dressings applied to the incisions. Healing time is quicker than traditional open shoulder surgery — athletes can usually return to action within a few weeks to a month. On the other hand, I think it’s fair to say that Nightwing running off an hour or two later to resume the good fight is not one of his better ideas. He must not be particularly fond of using that shoulder.

Depending on the location and extent of the surgery, general, epidural, or local anesthesia can be used. Alfred is grousing because Nightwing asked only to use lidocaine — a local anesthetic — for the surgery. Given the wound location, this is actually a reasonable choice. The lidocaine could be used as a local anesthetic or to provide a brachial plexus block (the brachial plexus is a collection of nerves in the shoulder that contains all the nerves of the arm). The latter would be the best option, but as it affects the entire arm and takes several hours to wear off, it would limit Nightwing’s ability to go gallivanting across the rooftops later that night.

Other thoughts:
Nightwing tells Alfred to avoid nicking a nerve, which is an unusual request as there are no nerves in the shoulder joint. He might be referring to the incision into the shoulder, but at the time he says it, Alfred’s already well into the operation.

The arthroscope doesn’t provide any advantage in removing the bullet from the wound in Nightwing’s side. It’s not a bullet lost in a wide-open joint, but instead one lodged in the abdominal muscles. A standard surgical exploration would be best.

I see that Alfred is not wearing eye protection or wearing a full surgical gown. Given that he considers Nightwing “family,” he might feel that these aren’t necessary. Anyway, I doubt OSHA is likely to spring an inspection on the Batcave.

I suspect Alfred reads the journal Arthoscopy. From the June 2007 issue of the journal, in the abstract of an article entitled Acute Arthroscopic Removal of a Bullet from the Shoulder:

“Bullets and lead particles in synovial fluid dissolve in time and cause periarticular fibrosis, chondrolysis, hypertrophic arthropathy, and sometimes chronic lead intoxication.”

Here’s what our favorite surgeon/butler tells Nightwing:

“…otherwise the lead particles in the synovial fluid could dissolve in time and cause periarticular fibrosis, chondolysis, even hypertrophic arthropathy.”

As usual, Rags Morales provides solid medical-related art. However, if I, if I really wanted to nick-pit, I would point out that arthoscopic images are always round (because the camera looks through the round scope — and speaking of cameras, there doesn’t seem to be one attached to the scope. It should fit over the eyepiece).

One last thought: Alfred’s priorities and sense of timing are horrible. Nightwing showed up to the Batcave bleeding from a bullet wound. Alfred’s first priority was to stop the bleeding. After accomplishing that, there was little need for him to perform joint surgery and remove the bullets at that time. The complications he describes are all chronic conditions and would take weeks, if not months, to occur. If he knew Nightwing was going to finish his mission as soon as possible (and you know he did), then Alfred should have postponed the surgery until later and spare Nightwing any surgical complications and need for recovery while fighting crime that night.