Orthobullets

Here are interop & postop images of yesterday's case by Peter Apel, MD, PhD and Ammer Dbeis DO, MS. BOTH-BONE FOREARM FRACTURE WITH COMPLETE MEDIAN NERVE LACERATION AND 1.5 CM GAP IN 14M PROCEDURE 1 (9/2/24): I&D, ORIF, carpal tunnel release, median nerve provisional repair with temporary nerve conduit. PROCEDURE 2 (9/9/24): Right median nerve reconstruction with reversed contralateral sural nerve autograft. Here is the link to the clinical presentation and the pre-op imaging: https://bit.ly/3AUfEZo HPI: A 14-year-old right-hand dominant male presents for evaluation of an open right forearm deformity after a fall while playing soccer. He also endorses numbness and tingling in his right thumb, index, and long fingers. PMH: His past medical history is significant for Iron deficiency anemia, chronic cough, and seasonal allergic rhinitis. PE: On physical exam, there is an open volar deformity of the right distal forearm with exposed radial and ulnar metaphyseal bone. There is a palpable radial pulse. There is diminished sensation in the hand in the median nerve distribution. There is no tenderness to palpation in the hand or elbow. How would you manage this patient? Share your thoughts and contribute to academic discussion. Vote on this case and Earn FREE CME: https://lnkd.in/gC62D8Yz Medical content: Contains clinical imagery

Can you answer our FREE Question of the Day? A recreational basketball player presents to your clinic with the injury shown in Figures A and B after colliding with the rim while attempting to block the final play of the game. When treating metacarpal neck fractures of the small finger, how much angulation can typically be maximally accepted if planning to treat the patient non-operatively? 1. 0-10º 2. 10-15º 3. 20-30º 4. 30-40º 5. 50-70º QID: 218173 Comment your answer below, then check to see if you got it correct by clicking the link below to see the answer & explanation. https://bit.ly/4fWBzxE #orthopedics #orthopedicsurgeon #orthopaedics #orthopaedic #orthopedic #ortholife #orthobullets #orthoresidents #orthoresident #orthoresidency #medicalschool #medicalstudent #medstudent #doctor #physician

Can you answer our FREE Question of the Day? A 65-year-old male is transferred to a tertiary care facility with concerns of sepsis secondary to periprosthetic joint infection. Interventional radiology performs an aspiration (Figure A) which is positive for chronic periprosthetic joint infection. He undergoes explant, antibiotic-imbued cementation of the resultant bone defect, and spacer placement with adjunctive antibiotic beads (Figures B & C). Over the next 6 months, the patient completes a prolonged course of IV antibiotics followed by an antibiotic holiday. He obtains updated labs demonstrating a serum ESR of 10 mm/hr (normal 0-22 mm/hr) and CRP of 0.4 mg/dL (normal <0.5mg/dL). A hip aspiration is performed (Figure D) resulting in negative alpha defensive, negative leukocyte esterase, synovial WBC of 1,000 cells/mL, and 74% neutrophils. A CT scan confirms a subtle fracture nonunion between his anterior and posterior columns beneath the cemented pelvic defect. He continues to endorse groin and thigh pain limiting his ability to perform transfers or walk. He would like to return to a reasonable level of independent functioning. Which of the following would be the most appropriate next step in management? 1. Remove current implants, place an antibiotic spacer with a cemented constrained liner followed by 6 weeks of intravenous antibiotics 2. Remove current implants, revise the femoral stem, utilize bulk allograft to fill the pelvic defect, and cement a constrained liner into the bulk allograft 3. Remove current implants, revise the femoral stem, place an independent acetabular cage to bridge the defect, and cement a constrained liner into the cage 4. Remove current implants, revise the femoral stem, utilize a custom triflange acetabular component 5. Explant current implants as a Girdlestone procedure QID: 218168 Comment your answer below, then check to see if you got it correct by clicking the link below to see the answer & explanation. https://bit.ly/4i3N0p8 #orthopedics #orthopedicsurgeon #orthopaedics #orthopaedic #orthopedic #ortholife #orthobullets #orthoresidents #orthoresident #orthoresidency #medicalschool #medicalstudent #medstudent #doctor #physician

Here is a new case by Dr. Peter Apel, MD, PhD and Ammer Dbeis DO, MS Dbeis and Carilion Clinic Orthopaedics. BOTH-BONE FOREARM FRACTURE WITH MEDIAN NERVE INJURY IN 14M HPI: A 14-year-old right-hand dominant male presents for evaluation of an open right forearm deformity after a fall while playing soccer. He also endorses numbness and tingling in his right thumb, index, and long fingers. PMH: His past medical history is significant for Iron deficiency anemia, chronic cough, and seasonal allergic rhinitis. PE: On physical exam, there is an open volar deformity of the right distal forearm with exposed radial and ulnar metaphyseal bone. There is a palpable radial pulse. There is diminished sensation in the hand in the median nerve distribution. There is no tenderness to palpation in the hand or elbow. How would you manage this patient? Share your opinion with the Orthobullets community about this case by joining the discussion and taking the poll on our site! Vote on this case and Earn FREE CME: https://lnkd.in/gC62D8Yz *Medical content: Contains clinical imagery*

Can you answer our FREE Question of the Day? A 72-year-old female presents to the clinic failing nonoperative management of left tri-compartmental osteoarthritis. She undergoes an uncomplicated total knee arthroplasty and does well postoperatively (Figures A & B). Three years later, she falls down her stairs at home and undergoes surgery for her distal femur periprosthetic fracture at an outside facility. She returns to your clinic approximately 3 months later complaining of continued pain requiring prolonged narcotic use. She has remained on partial weight-bearing status since her most recent surgery but endorses feelings of knee instability/buckling during physical therapy sessions. The incision appears healed and there is a moderate effusion with a notably limited range of motion. Her most recent radiographs are shown in Figures C & D. Which of the following is the most appropriate next step in management? 1. Initiate progressive strength training and a return to walk protocol with physical therapy 2. Order inflammatory labs and perform a joint aspiration with synovial fluid analysis 3. Refer the patient to a durable medical equipment provider for a bone stimulator 4. Perform hardware removal, deformity correction, and revision open reduction internal fixation 5. Perform hardware removal and conversion to distal femur replacement QID: 218160 Comment your answer below, then check to see if you got it correct by clicking the link below to see the answer & explanation. https://bit.ly/4hQU2h0 #orthopedics #orthopedicsurgeon #orthopaedics #orthopaedic #orthopedic #ortholife #orthobullets #orthoresidents #orthoresident #orthoresidency #medicalschool #medicalstudent #medstudent #doctor #physician

Here is a clip from our latest episode of CoinFlips & Controversies, “Progressive Shoulder Pain in 76F” featuring expert faculty from the 2024 New York Shoulder Arthroplasty Course (taking place Dec. 13-14, 2024 at the InterContinental New York Barclay in New York, NY.) Watch Drs. John Sperling & Dines, discuss “Don’t Forget Your Physical Exam When Selecting Anatomic vs. Reverse Total Shoulder”. Click here to learn more about NYSAC and watch their full webinar on Orthobullets: https://lnkd.in/ghGVTap8 #orthopedic #orthopedics #orthopedicsurgery #orthopedicdoctor #orthopedicsurgeon #medicalstudent #medicaleducation #residency #residencylife

Can you answer our FREE Question of the Day? An 82-year-old female presents with hip and groin pain. She states she enjoys walking 1-2 miles per day with her daughter and grandkids; however, she is having difficulty putting on her shoes due to the pain and limited range of motion. The pain now wakes her up at night and prevents her from doing everyday activities like going grocery shopping. Her hip radiographic imaging is shown in Figure A. She is otherwise healthy and is ultimately indicated to undergo total hip replacement surgery. Which of the following techniques is the most appropriate when utilizing polymethylmethacrylate (PMMA) cement for this patient’s case? 1. Utilizing cement for achieving femoral stem fixation 2. Cementing the acetabular cup to achieve fixation 3. Avoid utilizing cement; utilize a diaphyseal-engaging implant 4. Mixing 4.5g of antibiotics per bag of cement for infection prophylaxis 5. Choose the smallest diameter implant to ensure a cement mantle >1cm thick QID: 218152 Comment your answer below, then check to see if you got it correct by clicking the link below to see the answer & explanation. https://bit.ly/4fWBzxE #orthopedics #orthopedicsurgeon #orthopaedics #orthopaedic #orthopedic #ortholife #orthobullets #orthoresidents #orthoresident #orthoresidency #medicalschool #medicalstudent #medstudent #doctor #physician

New expert video by Richard Fessler, MD of Rush University Medical Center at the 2023 Selby Spine Conference. Click here to watch the full video on Orthobullets: https://lnkd.in/gQT2eUSH #orthopedic #orthopedicsurgery #medicalstudent #medicaleducation #residency #spineinjury #spinesurgery Foundation for Orthopaedic Research and Education (FORE)

Can you answer our FREE Question of the Day? A 65-year-old female electively undergoes the procedure shown in Figure A. She has a remote history of breast cancer treated with lumpectomy and has been receiving conjugated estrogen therapy from her nurse practitioner since the initiation of menopause. She has chronic, painless varicose veins on both legs and states that she had a "clot in her leg" once after a flight to Australia nearly 30 years ago. Which of the following is most true regarding the use of postoperative duplex ultrasonography in this patient? 1. A bilateral duplex screening ultrasound is a cost effective measure after routine total hip arthroplasty but not after total knee arthroplasty 2. History of prior unprovoked deep vein thrombosis (DVT) is an absolute indication for post-operative screening duplex ultrasonography 3. Routine use of post-operative duplex ultrasonography is strongly recommended against after elective joint replacement surgery 4. The data on the use of post-operative screening ultrasound for deep vein thrombosis (DVT) is inconclusive 5. Women on estrogen therapy should be screened with duplex ultrasonography after elective joint replacement surgery QID: 218148 Comment your answer below, then check to see if you got it correct by clicking the link below to see the answer & explanation. https://bit.ly/3ZcZx2o #orthopedics #orthopedicsurgeon #orthopaedics #orthopaedic #orthopedic #ortholife #orthobullets #orthoresidents #orthoresident #orthoresidency #medicalschool #medicalstudent #medstudent #doctor #physician

Here are intraop & postop images of yesterday's case by Dr. Jon Barlow and Mayo Clinic. RSA PERIPROSTHETIC HUMERUS FRACTURE IN 75F PROCEDURE: ORIF L HUMERUS Here is the link to the clinical presentation and the pre-op imaging: https://lnkd.in/gFWhjTyE HPI: This is a 75-year-old female who is 9 months status post left reverse total shoulder arthroplasty. She has had a series of falls and presents with left shoulder pain. PMH: The patient has a history of osteoporosis and pancreatic cancer, currently in remission following a Whipple procedure. The patient has a BMI of 19, indicative of a low body mass index. PE: On physical exam, she has pain and a limited range of motion. She is neurovascular intact distally. How would you manage this patient? Share your opinion with the Orthobullets community about this case by joining the discussion and taking the poll on our site! Vote on this case and Earn FREE CME: https://lnkd.in/gPrNFSws