Benjamin Shore

@deln_ioann @Davembmd Cast all day long It will remodel beautifully

A Greek family living in Miami sent me the following images. The child was first evaluated in the Emergency Department and subsequently by a private pediatric orthopedic surgeon. The second set of radiographs reflects the current status, at 2 weeks post-injury. @Davembmd

@azhar_darokhan @AOFoundation @AOTrauma @AOTraumaNA @ao_india @orthobullets We found a cast for longer than 2 weeks was associated with elbow stiffness pubmed.ncbi.nlm.nih.gov/26536011/

A 7 yr old Girl had a traumatic closed Elbow dislocation with avulsion # of medial epicondyle with intact DNVS I did closed reduction & applied an above elbow Fiber cast check xrays posted along #orthotwitter Should I manage the medial epicondyle avulsion # conservatively?

@southNJscoli @deln_ioann Agree, 100%. Be mindful and sometimes even take a traction Xray to be prepared for intercondylar split in tea type fracture. These can sometimes behave well with hybrid fixation, including a cannulated screw across the distal humerus and K wires for the supracondylar component

@deln_ioann yes but make sure it’s not a T. i’m a little more likely to cross screws, but it’s still ok to do wires and may actually be better in some cases

👉 Is it normal for a 11-years old to have a supracondylar ? Any advice or as usual ?

Annual Bch peds ortho fellowship fishing trip was another success Fish ✅ Injuries 0️⃣ We missed a few fellows but great times had by all Thanks to @jaxcharter #pedsortho #stripedbass

@southNJscoli @Davembmd @bonesmith_ @centerofhip @InvictaOrtho @FractureDoc @DrFraneNicholas Nonop for sure

@Davembmd @bonesmith_ @centerofhip @InvictaOrtho @FractureDoc @DrFraneNicholas @BenjaminShoreMD i’ve treated a lot of these non op, i’ll admit it’s harder than fixing it by far for patient and Dr. Depends on the patients risk tolerance i think either are acceptable at least in kids.

What’s the lowest you will go anterolateral for a humerus shaft fracture? What approach would you have for this one? @centerofhip @InvictaOrtho @FractureDoc @DrFraneNicholas #orthotwitter

@BostonChildrens Ortho team is headed at @POSNA_org annual meeting!

@deln_ioann I think the challenge here is that we don’t really know what the effects long-term are of guided growth in particular for ambulant children. Guided growth creates a Perthes like hip, which can lead to abductor fatigue and trochanteric and impingement in the long term.

@BenjaminShoreMD Definitively not high. Maybe low but i would say the kid is normal, with playing/climbing/running etc.

👉 What is your strategy with these 2 - cases ? 1) 5 years old. Do you proceed with dvo osteotomy for coxa valga? Hip dysplasia ? Do you wait for sth ? 2) multiple hereditary exostosis : Same question here

@southNJscoli @Orthopedist12 @CPOrthopedics @Davembmd @traumaticum @DrBhavinJadav Both

@BenjaminShoreMD @Orthopedist12 @CPOrthopedics @Davembmd @traumaticum @DrBhavinJadav your eyesight is better than mine (or your wearing glasses) 😂😂😂

12 yr old , 2months old, tried conservative outside, have come to me at this stage.... what will be your line of treatment??@CPOrthopedics @Davembmd @traumaticum @DrBhavinJadav

@craftbeerguy75 @GinoHard_ Twice bennet has done that to the leafs in the playoffs - he needs discipline - where is Reavo when you need him

@GinoHard_ That’s not good. Any discipline coming for Bennett?

Anthony Stolarz was seen vomiting into a bucket before being pulled from the game 😬🤮 (via Sportsnet)

@southNJscoli @Orthopedist12 @CPOrthopedics @Davembmd @traumaticum @DrBhavinJadav In my opinion, you don’t need to get a bone age. The back of the proximal tibia is closed so I would nail her rigidly

@Orthopedist12 @CPOrthopedics @Davembmd @traumaticum @DrBhavinJadav needs to be fixed i’d get a bone age first. ESIN are great but they usually leave ~ 5 degrees of malreduction. if this is a female she might be ready for a rigid nail though it would be less of a chance. If the bone age was sanders 6 or more i’d probably do rigid nail

@KPapetti LFG

Today's mood

@southNJscoli @Survive_Repair I think greatest risk occurs in adolescents probably over 12 yrs of age for boy and maybe 11 for girls

@BenjaminShoreMD @Survive_Repair definitely significant Sn/Sp issues with database studies for this question. It’s even hard with large scale study, because you almost have to make your study variable “symptomatic” VTE as the rate and significance of occult VTE is unknown

Okay ortho friends, time for me to learn. Those of you who treat kids/teens for sports/peds/trauma, what is your stance on DVT prophylaxis? Specifically bilateral lower extremity polytrauma. Weight based or age based? I looked on pubmed and guidelines and got no clear answer.

@southNJscoli @Survive_Repair Yes I think this study has a bit more merit because not based on a database but actual patients. The challenge with large databases is the the VTE diagnosis is often secondary which affects the accuracy of the results and conclusions. Great work all

@InvictaOrtho pmc.ncbi.nlm.nih.gov/articles/PMC11… here’s one we did looking at 13 centers in the US something like 10 million patients. My takeaway is it’s more age based when you aren’t talking about line related ones. @BenjaminShoreMD ?@Survive_Repair ?

@southNJscoli @InvictaOrtho For me I look at age, infection and central line Those are primary risk factors - infection is the biggest risk factor Secondary are family history of vte, oral contraception and obesity

@InvictaOrtho @BenjaminShoreMD ?

@southNJscoli @InvictaOrtho pubmed.ncbi.nlm.nih.gov/40094076/

@southNJscoli @InvictaOrtho pubmed.ncbi.nlm.nih.gov/38188190/

@southNJscoli @InvictaOrtho Sorry for the delay here are a few good papers to consider

Learning from a very bright and skilled group of pediatric orthopedic surgeons at the @AACD

@JasonJHoward1 @Nemours @NemoursOrtho 👋 Unni

@BenjaminShoreMD @Nemours @NemoursOrtho

Some last minute changes before my talks at POSNZ in Auckland this morning. Glad to be back in New Zealand! ⁦@Nemours⁩ ⁦@NemoursOrtho⁩