Medical student orthopedic rotations are in full swing. This week in the operating room,. I asked a few questions about basic anatomy, and unfortunately, the student didn’t get most of them correct.
After the case, the student asked, “What can I do to improve?” I emphasized the
With permission...
Great comments from everyone. Due to the comminution, I did a nail + monster plate construct. WBAT. Nail was done percutaneously and the plate was slid up laterally once the nail was placed. Full case:
87 F with left knee pain after a fall. Had a left hip fracture 12 years ago and continues to be very active, lives alone, drives, and is an active member of the community.
We are seeing a rise in periprosthetic fractures as TJA numbers climb. It's clear we've got a growing
Hey medical students, residents, APPs what should you be thinking about if you see this x-ray? Answer below and click on this link to see a related case.
My son is learning about bones at school. He told me the the femur is his favorite, because it’s “just the best bone dad.”
#simpletruths
#orthotwitter
#orthoX
Whats the WORST thing a surgeon could say or do in the middle of an operation that might give off an unfortunate ‘bad omen’ vibe?
My resident the other day reduced the fracture then high fived 👋 our surgical tech.
We now have a new rule. Mid case high fives have been
25 M who has pain with weight bearing since a foot sprain a couple weeks ago. This is the bottom of his foot. X-rays were read as normal. Name that injury.
#orthotwitter
#orthoX
@orthobullets
@generalorthomd
@UHC
How do you expect them to make over 5 billion last quarter if they approved the medically necessary surgeries? Patients are suffering. .
One of my favorite clamps and instruments is the colinear reduction clamp. What’s your favorite instrument and a must have in your 🧰?
#orthotwitter
#orthoX
@orthobullets
So much information on X-rays. Agree with all that’s been said.
Anterior Sail sign
Posterior fat pad
Anterior humeral line should intersect the middle third of the capitellum in children > 5 years old
Non op vs CRPP. If CRPP what’s your pin configuration?
A 38 M was playing soccer and swears he was hit from behind. See anything on these x-rays? What's the diagnosis? What would you do?
#MedTwitter
#orthotwitter
61 M with right shoulder pain after a fall from a ladder. Works in construction, lives alone. How would you treat?
#orthotwitter
#medtwitter
Full case:
Over 2 years ago about 44% of surgeons chose to do a hemi vs THA for this fairly healthy 76F. What would
#orthotwitter
do today? Has there been new evidence to help guide us? Vote on
@shaunpat1
case today
Here are the post-op films for this case ()
I placed the patient lateral, attempted closed reduction and wasn't even close! Chose to do a mini-open, clamp, cerclage, and then nail. Immediate WBAT.
I added the intra op films in a comment.
#FractureFriday
! How would you manage this proximal femur fracture in this 77F? What position, implant choice, and approach?
#orthotwitter
. Case link
Doing another Lunch & Learn for our APPs. Last month reviewed emergencies like open fractures, compartment syndrome, and common dislocations. Thinking of other topics and other injuries Any suggestions or contributions?
@rkh_md
@TraumaSoapBoxes
@generalorthomd
#orthotwitter
Great comments and discussion. As
@InvictaOrtho
@hjluks
and others suggested need to thoroughly discuss options. Went over pros and cons. To get the patient moving and hopefully back to work sooner, patient underwent fixation. Looks like most would have plated. Not perfect.
61 M with right shoulder pain after a fall from a ladder. Works in construction, lives alone. How would you treat?
#orthotwitter
#medtwitter
Full case:
35M with left thigh pain after an MVA. No other injuries. This comes in at 10 PM. When do you take to the OR? Do you place in traction if in AM? Starting point? Position?
#orthotwitter
#EMtwitter
#MedTwitter
Thrilled to announce the release of a new orthopedic textbook co-edited with John Riehl focusing on the latest fracture treatments and global trends in orthopedics.
This book challenges and expands on conventional wisdom to ensure the best care for patients with authors from
87 F with left knee pain after a fall. Had a left hip fracture 12 years ago and continues to be very active, lives alone, drives, and is an active member of the community.
We are seeing a rise in periprosthetic fractures as TJA numbers climb. It's clear we've got a growing
#orthoresidents
,
#EMtwitter
#medicalstudents
In our latest webinar,
@dr_nls
and I explored approaches to tackling calcaneus fractures. Don't overlook these injuries.
Given its high propensity for posterior soft tissue complications, swift action and often an emergency OR visit
Non-compete agreements for physicians potentially reduce the quality of patient care without improving it. Ending non-compete agreements will benefit both physicians and patients.
If you could vote tomorrow, what would be your vote?
Even a CT isn't fail-proof. Always exam the neck! I follow a checklist I was taught in fellowship. 1. Examine the femoral neck 2. Check rotation 3. Check Length 4. Knee Exam 5. Compartments/pulses. What's your protocol/checklist for femur fractures?
#orthotwitter
35M with left thigh pain after an MVA. No other injuries. This comes in at 10 PM. When do you take to the OR? Do you place in traction if in AM? Starting point? Position?
#orthotwitter
#EMtwitter
#MedTwitter
What are some of your favorite sayings in the OR and words to live by when operating and teaching
#orthotwitter
#MedTwitter
? I love to stress that “slow is smooth and smooth is fast.”
Hey
#orthotwitter
summer is here and that means more high energy fractures and compartment syndrome. Who is doing a single vs dual incision fasciotomy for the lower leg?
This study found “Patients with DI fasciotomies were more than twice as likely to develop a SSI compared to
Pure beauty. Proving once again that most clavicle fractures heal and don’t need plates. No pain and asked the tech why they were getting an X-ray? (Patient was following up for a femur fracture as well).
Great case for medical students and residents to learn from. What deformity (s) are you expecting to counteract here? What tools (ie reduction aids) at your disposal would you have available?
April 2nd
@6
pm est we are having an online fracture conference. Let’s continue to learn from each other during these challenging and chaotic times of
#COVID19
. Interested?Share your email in the form to get the link.
#medtwitter
#ortho
A friend shared some X-rays and cases with me that revealed this particular “nail/plate” combo having issues with the locking screw backing out post-op 😕. Has anyone else encountered this?
@rkh_md
@traumaticum
@InvictaOrtho
@jamesablairMD
Curious what the
#orthoX
(formerly known as
#orthotwitter
) community thinks of this recent publication in
@jbjs
. I can sum it up in one word TEAM.
*Johns Hopkins Hospital launched a process improvement initiative for OR efficiency in outpatient orthopaedic cases, emphasizing a
Revised the nail: full arthrotomy to correct starting point, added a lateral blocking screw to correct the valgus alignment. WBAT post op. Patient followed up once so I assume he did awesome 🫣
Found this case in the archives. 70M underwent IM nailing out of state after a ski accident and shoes up NWb in a cast after 5 months. Bone Stim? Keep vs revise? Plate vs Nail?
#orthotwitter
#MedTwitter
@orthobullets
Geriatric ankle fractures continue to have high rates of complications. Should we be nailing or plating them? What does
#orthotwitter
think of this new study?
New residents just started and fellows are on their way. It's critical to know ways to reduce exposure. Radiation Exposure Among Orthopaedic Trauma Surgeons:... : Journal of Orthopaedic Trauma
Found this case in the archives. 70M underwent IM nailing out of state after a ski accident and shoes up NWb in a cast after 5 months. Bone Stim? Keep vs revise? Plate vs Nail?
#orthotwitter
#MedTwitter
@orthobullets
So why did hospitals get an inflationary increase but not physicians?
“According to the AMA, if physicians got an inflationary adjustment similar to that of hospitals and other health professionals, they would have seen a 4.6% increase in payment in 2024.”
As many have suggested, we need to be concerned about the Lisfranc joint (). It's very common for many of these patients to have a delay in diagnosis.
These are WB x-rays taken over two weeks after the injury. Note the widening on the right foot. I think
25 M who has pain with weight bearing since a foot sprain a couple weeks ago. This is the bottom of his foot. X-rays were read as normal. Name that injury.
#orthotwitter
#orthoX
@orthobullets
33 M involved in a MVA with a closed tibia and humerus fracture. Initially the radial nerve is working but acutely stops after splint application. What would you do?
#orthotwitter
#MedTwitter
Physical examination is key. Also never forget the importance of looking beyond the bones. A disrupted Kager's fat pad could indicate an Achilles tendon injury as in this case. What's everyone's preferred treatment? Op vs. non op? If operative, what technique?
The full case is
A 38 M was playing soccer and swears he was hit from behind. See anything on these x-rays? What's the diagnosis? What would you do?
#MedTwitter
#orthotwitter
Happy to be a small part of this project led by John Riehl MD. Looking forward to the next one. Will definitely need to get some input from
@traumaticum
on the next version. We need more teaching cases from
#aroundthebone
and
#aroundtheworld
Saw a recent
@otatrauma
forum post discussing the use of MRIs and the safety concerns associated with external fixators. It’s clear that many polytrauma patients require MRI scans for their various injuries. Interested to hear the thoughts and practices of the
#orthotwitter
The starting point remains the same regardless of the approach (semi-extended, patella tendon splitting, etc). What's everyone's preferred approach? Was at a resident course a couple months ago, and more than 90% had ONLY seen a suprapatellar.
@rkh_md
@traumaticum
@lisacannada
The recommended starting point on the tibia for guide wire and intramedullary (IM) nail fixation is at the medial edge of the lateral tibial eminence.
Learn more on our DAILY Orthobullets podcast.
#orthotwitter
What’s the best way to fix some of these fractures? All treatment options have associated risks. This was a poster at this years
@otatrauma
meeting.
#ota2022
@TexasTech
Femoral neck fxs are highly morbid injuries & are the most expensive fractures to treat. Treatment options include multiple cannulated screws (MCS) fixation, sliding hip screw (SHS), hemiarthroplasty & THA.
Learn more on our podcast.
#orthotwitter
In a previous post we discussed the importance of anatomy for medical students. Physicians, surgeons, and healthcare professionals from around the world provided many great insights.
Another important aspect of orthopaedic education is evaluating X-rays.
What is your
64M with long standing ankle pain after multiple sprains as an athlete in college. Now is a farmer and still loves to fish, golf, and work. Would prefer to have one surgery that lasts and wants to stay active. Fusion or replacement?
#orthotwitter
#MedTwitter
I came home and my daughter asked “can you fix this boo boo?” The first thing that came to mind was whether I should use a nail or a plate for this intertroch fracture?
#orthotwitter
With new residents and students starting and summer in full swing, great time to review compartment syndrome. Always be on the lookout when evaluating patients!
#OrthoX
We are getting ready for our next journal club and the topic is Traumaplasty.
In celebration of March Madness, we're introducing Periprosthetic Madness, inspired by the increasing rates of arthroplasty.
We want to explore this topic in depth. What articles and topics do you
The Hoffman sign, a simple yet crucial component in physical exams. I had a case where a patient came to me with all their normal imaging for his ankle giving way and falls. Heeding the advice I always remember from a mentor, “Examine the patient.” It turned out he wasn’t
True Jones fractures involve a vascular watershed area, and non-union is reported to be as high as 15-30%. The treatment of choice is with an intramedullary compression screw.
Learn more about 5th Metatarsal Base Fracture on our podcast.
#orthotwitter
Not surprised by the poll results. Recently a PGY-3 was doing a tibial nail with me. We were using an infra Patella approach, they asked me where to find the technique guide for this “new, cool approach that doesn't go through the knee.”
#orthotwitter
#orthoX
Can you answer this daily question from our Free QBank correctly?
QID: 218834
Comment your answer below, then check to see if you got it correct by clicking the link below to see the answer & explanation.
#orthotwitter
#MedTwitter
As we enter 2024, I'm filled with excitement and gratitude for what the team
@medbullets
and
@orthobullets
has accomplished. The dedication to advancing orthopaedic and medical education has made a global impact. Thank you to the incredible community who make all of this
Great insights shared by Dr Deana Mercer on treating distal radius fractures
The video provides a nice explanation of the extended FCR approach and offers tips for achieving an anatomic reduction.
Calling all residents, med students and
#orthotwitter
.🔬 Join us for a deep dive into our latest
@orthobullets
case study on clavicle fractures. Don’t miss this chance to expand your knowledge, ask your burning questions, and engage in stimulating discussion regarding indications
Here is a new case by Dr. Nikhil Verma (
@DrNikhilVerma
) and Midwest Orthopaedics at Rush (
@MOR_Docs
).
MIDSHAFT CLAVICLE FRACTURE NONUNION S/P ORIF IN 23M
How would you manage this
#orthotwitter
?
Vote on this case for CME:
A tibial plafond fracture (also known as a pilon fracture) is a fracture of the distal end of the tibia, most commonly associated with comminution, intra-articular extension, and significant soft tissue injury. Diagnosis is typically made through clinical evaluation and confirmed
Wow, it's incredible to see the number of news stories, social media posts, and discussions regarding yesterday's FTC ruling.
The ruling to ban non-competes marks a significant shift, particularly for the healthcare industry and its physicians. Having discussed this with several
Proximal tibia fractures can be difficult to manage. Apex anterior and valgus deformity are common. Entry point is key.
I would do this nail in the semi-extended position and I would have a low threshold to use blocking screws. Don't need specialized instruments to nail if using
What’s your “go to” when fixing femoral neck fractures in young patients? Cannulated screws, SHS, proximal femur plate etc? Been seeing more of the new proximal femoral plating systems being used.
@rkh_md
@jamesablairMD
@traumaticum
Femoral neck fxs are highly morbid injuries & are the most expensive fractures to treat. Treatment options include multiple cannulated screws (MCS) fixation, sliding hip screw (SHS), hemiarthroplasty & THA.
Learn more on our podcast.
#orthotwitter
Had a busy and fun day in the OR. Great cases and tunes today. What's the
#1
song on your playlist that gets your adrenaline pumping and ready to rock the OR?
#orthotwitter
Virtual Trauma Call Case. 25 M with arm pain after a motorcycle accident. What other injury(s) are you worried about? What's your plan? Approach?
#orthotwitter
Showed these X-rays at a resident conference the other day and a couple asked why were there staples below the knee cap?! I usually use a supra patella approach these days, but still good to know multiple ways to treat an injury. What is your preferred approach?
#orthotwitter
Hey
#orthotwitter
. As a surgeon who is fairly healthy, non smoker, non diabetic say in your 40s... are you getting your Achilles fixed? Does age matter? What would lead yourself to have surgery or not?
#scientifictwitterpoll
Hey
#orthotwitter
61 yr old , well controlled diabetic, stage actor. Mid substance rupture of TA, 2.5cm gap in neutral position of foot.
Conserve/ fix?
If conservative, what should be the protocol?
If fixing, what is your preferred technique?
@FootAndAnkleMD
@orthotraumamd
~20-25% of distal radius metaphyseal fxs re-displace early after closed reduction and casting. Indications for surgery in kids >10 years old include: angulation >20 degrees and rotation >30 degrees.
Learn more on our DAILY podcast.
#orthotwitter
Hey
#orthotwitter
. Just curious, what’s the official penalty for someone who ‘borrows’ your OR lead and misplaces/steals your thyroid shield while you’re out?
#FractureFriday
! How would you manage this proximal femur fracture in this 77F? What position, implant choice, and approach?
#orthotwitter
. Case link
Vascular injuries are a serious risk in orthopedic procedures. It’s crucial to have a thorough understanding of the anatomy and the specific areas at risk. This knowledge not only helps in preventing these injuries but also in recognizing them early when they do occur. Stay
The morning's grand round talk by
@Drlyndonmason
was incredible. One of the statements that really resonated with me was.
"Question everything. Always look at your results."
@IU_Health
@IUOrthoSurgery
.