Internet I need help!
My 9 yo trained all year, qualified for
@usaswimming
Junior Olympics, then COVID cancelled his season. His one (socially distanced) swim meet this year is today but mom and I are missing bc
#doctorlife
... Let’s cheer him on and get him some likes!
Insanity… nearly 50% of students never take call during 3rd year? We’re failing to educate an entire generation of physicians in graduated independence, time mgmt, fatigue and stress management during the period of training when they have the most protection/support! 🤦
Trends in Medical Education:
Decline in overnight call during third-year clerkships
(MD-granting medical schools, 2001-2019; no data available for 2013-2015)
Posting
#Match2024
Lenox Hill Hospital Orthopedic Surgery Department is offering a 1-year, Paid, Full-time Research Fellow position. Focus on Academic Total Joint and Shoulder Arthroplasty Research.
Email CV and Cover Letter to vlafage
@northwell
.edu if interested.
#orthotwitter
Dear Medical Schools:
How is this helpful to applicants or program? Honors is meaningless and High Pass is a fail… Particularly problematic for those applying to competitive specialties. Stop it!
Sincerely,
Program Directors everywhere
#Match2023
#ERAS
#Ortho
#Match2024
prelim data:
1️⃣ Mean apps per student down from 77 ➡️ 62. (MD only to 67)
2️⃣ ~20% reduction
3️⃣ Applicants still applying to > 2x total signals despite <1% chance of interview in 2023
(Credit
@jbcarmody
for data post)
#orthotwitter
@DGlaucomflecken
(Walks to podium at Orthopedics conference, taps mic)
Our evidence proves that The Robot performs all orthopedic cases better than surgeons, who can now spend all their time where it counts. In clinic providing emotional support, managing pain Rx and indicating pts for the Robot
@Orthofacts
legitimate consideration is whether this student can effectively engage w patients. Pts can be blatantly offensive, sexist, racist, political, you name it... I’ve had pts refuse a “yankee” doc or complain I was “I-talian.” need to be able to take care of them anyway
@OrthoFolks
This (sober) patient drove 4 hours from place of injury to my hospital while his drunk buddy immobilized C-spine from the rear driver seat.
🙏🇺🇸 I have so much gratitude for my years in military service. Take some time tomorrow to talk to veterans and learn their stories! Big thanks to
@NorthwellHealth
for sitting down with me.
#VeteransDay
via
@YouTube
Yet another study demonstrating that insurance status, an indirect reflection of socioeconomic factors as well as access to care, has significant impact on surgical outcomes.
New study from University of Rochester
@urmc_ortho
finds that insurance reimbursement status influences PROMIS scores following arthroscopic rotator cuff repair.
@NeoSoul87
Good news, you didn’t see a white power sign. It’s called the circle game. Popular in the military (and in my elementary school in 1980s). If you look at the circle the other person gets to punch you.
📢PSA
#Ortho
#Match2024
Applicants: Pls refrain from sending Letters of Interest during app review, particularly to programs you didn’t signal. This is disingenuous and outside spirit of the match. You have 30 “LOI” built in. Use accordingly.
#orthotwitter
Rising MS4 in good standing, underrepresented in ortho
Apply to mzacchilli
@northwell
.edu 4/1-4/17/23 rolling
▶️ Personal statement (300 or less)
▶️ One LOR (Ortho/Surg)
▶️ One letter of good standing
▶️ CV
▶️ Transcript.
▶️ USMLE Step 1 unofficial transcript
VSLO App required.
#Ortho
#Match2024
begins tomorrow at 10 a.m. EST, when applicants/programs find out IF they Matched, with formal Match announcements Friday at noon EST.
To all our applicants… Good luck!
Hospital staff / attendings… please be kind to your
#Ortho
hopefuls this week!
I always tell medical students to search for programs with shared ideology…. For authors of the hateful comments on this document, you need not look to our program at Lenox Hill Ortho
@NorthwellHealth
My mother touched innumerable lives as a friend, teacher, coach, and mentor... the outpouring of support has been humbling and uplifting. If you wish to honor her memory, please donate to this charity:
In Memoriam- Linda Zacchilli (Oliva Cancer Fund)
@jointdocShields
@ChadRuffinMD
That’s the game… they are a private organization. If rules stayed constant eventually nobody would need to pay them. Change useless rules for new “areas of emphasis” and justify existence.
In the military we’d refer to this as a “self-licking ice cream cone”
Interviews approach, early data on
#orthomatch2023
signaling:
1️⃣ Most programs were signalled on ~30-45% of their applications
2️⃣ Mean 211 Signals/program
3️⃣ Applicants used all available signals
4️⃣ Ortho was specialty most likely to signal beyond geographic preference
@AAOS1
Squats: The “ass to the grass” method your high school football coach preached really isn’t necessary. Partial range of motion has similar strength benefit, less risk for joint wear and tear. Also true for other joints/exercises.
#legday
#sports
#medicine
#TheMoreYouKnow
There is recent data to show that using partial ROM during resistance training may have some similar hypertrophic benefits when compared to a Full ROM (fROM) exercise.
@TCKMed
I have never had a name doppelgänger as neither unpopular vegetables nor Greek gods have worked at my hospital. And unfortunately even if they did I’m not getting confused for the latter. 🙄
Nonop ACL management:
Great thread to learn to read literature critically. Often quoted as proving ACLs “heal”, it shows ~25% coping rate. Optional delayed surgery pts reported lots of knee instability (40/50), and higher rates of “severe” Knee QOL deficits (27% vs 18%)
ACL Friday!
Lots of discussion lately about the ACL "healing." Let's critically evaluate the main study that has brought this to the mainstream, the KANON trial (a thread) 1/5:
Methods
120 pts randomized to rehab & optional delayed ACL recon vs early ACLR
#sportsmedicine
case conference:
24 yo bball PG➡️ HS auto ACL, did well, 5 mo pop large friend jumped on back➡️ Rev BTB allo (tunnels 13), full RTS 10 mo➡️ pivot inj 18 mo playing b-ball. 4 deg symmetric varus, slope 10, 7 recurv. MCL PCL PLC men intact
#orthotwitter
thoughts?
Cleared an inner city teacher today to return to dance/classroom 6 months out from major
#knee
#surgery
... and she
#moonwalked
out of the office. Always great
#ortho
#SportsMedicine
clinic when a patient graduates, but this one was special! 🌛👟
90% of surgical pre-auth denials:
“You didn’t include [blank] in your note.”
Peer review call:
“Actually that’s clearly stated in line 3 of the H&P, MRI report, and the discussion section.”
“Peer:”
Oh gosh, you’re right, we must have missed that.
Repeat ~6x/wk. Wonder why?l
Doctors at a major US insurance company deny tens of thousands of claims a month without even looking at patients’ files.
“We literally click & submit,” a former Cigna doctor told
@ProPublica
&
@Capitol_Forum
. “It takes all of 10 seconds to do 50 at a time.”
The inside story 🧵
@Orthofacts
Picked up this distal radius cast from Plastics guy w/o add’l hand fellowship who “covers fractures.” Keep in mind at least had brief residency training in area. Know limits... I don’t claim ability = pcp to treat DM, HTN
🖐🎤🚶♂️
#jpgsallday
#justsayin
@karenerrichetti
1. Orthopedic Sports Medicine surgeon with special interest in cartilage transplant and joint preservation.
2. Arthroscopic cases, medical education commentary. Also GIFs.
3. Call sign: The Dude (no really, Afghanistan 2013)
In case anyone needed proof that JCAHO is incompetent, here’s an article they published stating that anesthesia, dermatology, opthalmology and radiology are all more demanding than
#orthopedics
.
#orthotwitter
#medtwitter
Tips for new
#ortho
residents and attendings:
Try to learn early in training to be comfortable with “I don’t know.”
For docs who “fix” things, can be more difficult but equally important to learn, “I can help you, but I cannot FIX this.”
#orthotwitter
#medtwitter
#JulyCometh
84% of health care professionals buy a coffee everyday.
Surgeons (ortho and general) drink more than most.
But coffee isn't all good.
Some Things You Need to Know About Coffee 🧵
(apologies in advance if I ruin your day)
Garden Classification Learning Case:
Don’t mistake minimal displacement for low grade. Hip fracture classification is about stability... medial cortex is broken, head posteriorly rotated. Looks unimpressive but still Garden 3. Treat it like one, 🦿not 🔩
📷 Credit
@Ortho_Jake
#MRI
finds “tears” in large % of healthy pain free
#athlete
! Similar study in Navy recruits ➡️ 40% had labral tears in hip with no pain or history of
#injury
! Treat people not pictures! “tears” always need to be matched to the complaint!
#MedTwitter
Study: 13/21 MLB pitchers WITHOUT shoulder pain had labrum tears on MRI. If I was a MLB pitcher or agent, I’d never get an MRI of shoulder unless all other treatments had failed.
#MLB
10% traumas have missed injuries
1) Be vigilant. Complacency kills
2) Touch every joint. Twice
3) Xray all abrasions, + above/below all known injuries
4) VITAL: Empower patient, family, nurses, friends. Tell them abt 10%, ask them to share “new” complaints
#orthotwitter
#meded
For trauma pts., especially in high energy cases, if you see an abrasion without sharp pain on exam, and all they say is "it's just like a muscle ache or bruise". Get an xray! Found some broken bones recently with just a small abrasion and mild "ache".
#orthotwitter
Mixed feelings reaching out to patients as clinic/surgeries reopen... Uplifting to offer real help to those who’ve suffered in pain. Also sobering, as some calls reveal memorable patients, and wonderful people, who did not survive the virus. Two combat veterans today. RIP🇺🇸🙏
Now Online | Does Anterior Cruciate Ligament Reconstruction Improve Functional and Radiographic Outcomes Over Nonoperative Management 5 Years After Injury?
Knock knees (termed valgus collapse) ⬆️ stress on ACL... its 1 reason female athletes r high risk for ACL tears, also ⬆️ reinjury risk. Great video from
@LenMacPT
demonstrating in a postop patient. Also why hip abductor strength is so important in rehab.
Thanks to
@MaimoHealth
Ortho for the invite to lecture on
#ACL
and
#SaveTheMeniscus
at Grand Rounds today! Was great reconnecting with my former trauma attending
@Amrorthopedic
and returning the favor of resident education!
@SallamAminah
@pedsturgeon
If med schools like Yale make applications largely indistinguishable they just enhance school prestige bias. The “bottom third” Yale student disappears and all become top tier “Ivy” med students, perpetuating problem. Yale benefits, other schools won’t. Disclaimer: Harvard ‘03
Disclaimer: I do not treat Chubb nor have I seen MRI… but I don’t care what the MRI pics show, that was not “only” an MCL. Better exam and scope will overrule the MRI read IMO
Meniscus Transplant- a brief rant.
Active 33 yo, complete deficiency, pain, effusion, tibial edema, nonfocal gr1/2 tibial CM. Stable. Failed nonop. I discussed transplant.
2nd opinion doc: “That is a drastic surgery. I’ve never done one and I’ve never needed to.”
Dear Dr. X:
Important to educate youth athletes with
#ACL
injuries about realistic expectations and long term risk, general perception is higher success and lower midterm failure.
92% children & adolescents RTS following ACLR, but 13% re-rupture the graft & 14% have contralateral ACL rupture within mean 6yrs (Kay et al, 2018). Regardless of age, ACLR pts MUST pass discharge criteria before RTS!
LINKS ⬇️