C

@centerofhip Only a couple, MRI to check for ALVAL, expect posterior flap to possible be compromised, standard revision cup/stem unless scan shows bone loss, low threshold for Dual Mobility

@ChuOrtho Yes, any experience of revising these?

Diagnosis? THR done 14 years ago. Presents with right groin pain for 2 years. X rays are a year apart What's the problem? What next? #orthotwitter #orthoX

@sportsdoc2016 @traumaticum @orthotraumamd @InvictaOrtho Synthes 4.5 Proximal Femur Locking Plate. Have done 2 now.

Hey #orthotwitter has anyone seen this? If so, how’d you treat? 72 yo 1 month postop with new fall. @traumaticum @orthotraumamd @InvictaOrtho

@BMJOpenQuality Personally I use concentric as well, but you can’t really claim claiming savings of £2-3000 from paper printing/admin without quantifying how much it cost the trust annually to use concentric

Implementation of Digital Consent at Sandwell and West Birmingham NHS Trust: A Quality Improvement Project bit.ly/3Nmri4S

@DrEilidhMaria While trying to increase the ST8 rate would be great, it’s not worth it as most ST8s would have young kids with childcare costs and they would lose the childcare allowance and be worse off unfortunately

@aschwartz45 @CenterRotation @AAHKS Thank you! Did attempt the website but it gave 117 results! Any tips on further limiting the results?

@ChuOrtho @CenterRotation I’ll give you one more freebie, SAMO Duofit stem and adaptive cup with constrained liner. Next time, @aahks air.aahks.net !

@CenterRotation @aschwartz45 any idea what implant this is or the taper? Needs a revision. Primary done in Spain.

@RoshanaMN I’ve been pushing Intraarticular blocks wherever I’ve worked here.

I can’t believe what I’ve just heard! ED nerve blocks every reduction here 🇺🇸before Ortho reduce! ✨🦴I’m in a parallel universe 🦴✨

@traumaticum @stevemchale @orthobullets @OhioHealth @ClevelandClinic @rkh_md @denehy1 @schulte_ss @bonesmith_ @DrFraneNicholas @eric_novack @FractureDoc @itius I don’t know if I trust just one distal screw 🤣

@stevemchale @ChuOrtho @orthobullets @OhioHealth @ClevelandClinic @rkh_md @denehy1 @schulte_ss @bonesmith_ @DrFraneNicholas @eric_novack @FractureDoc @itius Never see the point of a second static screw I just leave them out

Here are intraop & postop images of yesterday's case by Dr. Ronald Peirish and Dr. Joaquin Castaneda. Dr. Peirish is a current trauma fellow at @OhioHealth Grant Medical Center, and future surgeon at @ClevelandClinic - Hillcrest Hospital. HIGH-ENERGY INTERTROCHANTERIC FRACTURE IN 22M PROCEDURE: OPEN REDUCTION AND FIXATION WITH A CEPHALOMEDULLARY NAIL Here is the link to the clinical presentation and the pre-op imaging: x.com/orthobullets/s… Do you agree with the treatment? Why or why not? Leave a comment and keep the great conversation going! #orthotwitter Vote on this case for CME: orthobullets.tiny.us/b4kvd3t8

@stevemchale @orthobullets @OhioHealth @ClevelandClinic @rkh_md @denehy1 @schulte_ss @bonesmith_ @DrFraneNicholas @eric_novack @FractureDoc @itius But why not put it in the second static hole and not the dynamic?

@ChuOrtho @orthobullets @OhioHealth @ClevelandClinic @rkh_md @denehy1 @schulte_ss @bonesmith_ @DrFraneNicholas @eric_novack @FractureDoc @itius I’m happy to have a second static screw if I’m never going to dynamise.

@orthotraumamd @orthobullets @OhioHealth @ClevelandClinic @rkh_md @denehy1 @schulte_ss @bonesmith_ @DrFraneNicholas @eric_novack @stevemchale @FractureDoc @itius What do you use the fibula plate in the distal femur for? Peaked my curiosity 🤣

@ChuOrtho @orthobullets @OhioHealth @ClevelandClinic @rkh_md @denehy1 @schulte_ss @bonesmith_ @DrFraneNicholas @eric_novack @stevemchale @FractureDoc @itius I am glad I am not the only one who uses the fibula locking plate here and the distal femur

@orthotraumamd @orthobullets @OhioHealth @ClevelandClinic @rkh_md @denehy1 @schulte_ss @bonesmith_ @DrFraneNicholas @eric_novack @stevemchale @FractureDoc @itius Looks good, I just contour a fibula locking plate with the locking cluster proximal and you get variable angle and do the same with it.

@orthobullets @OhioHealth @ClevelandClinic @rkh_md @denehy1 @ChuOrtho @schulte_ss @bonesmith_ @DrFraneNicholas @eric_novack @stevemchale @FractureDoc @itius Here’s a nice example of using a lateral base tension plate by Dr. Sean Campbell

@orthotraumamd @orthobullets @OhioHealth @ClevelandClinic @rkh_md @schulte_ss @bonesmith_ @DrFraneNicholas @eric_novack @stevemchale @FractureDoc @itius @denehy1 Fracture site would be too close to screw insertion, high risk for varus collapse would choose on axis over off axis fixation. Patient is 22, I would go long recon nail with screws up the neck. And a reduction plate that would act like a tension plate

@ChuOrtho @orthobullets @OhioHealth @ClevelandClinic @rkh_md @schulte_ss @bonesmith_ @DrFraneNicholas @eric_novack @stevemchale @FractureDoc @itius @denehy1 How do you choose which nail you use here? Any thoughts about a DHS?

Here is a new case by Dr. Ronald Peirish and Dr. Joaquin Castaneda. Dr. Peirish is a current trauma fellow at @OhioHealth Grant Medical Center, and future surgeon at @ClevelandClinic - Hillcrest Hospital. HIGH-ENERGY INTERTROCHANTERIC FRACTURE IN 22M How would you manage this #orthotwitter? Vote on this case for CME: orthobullets.tiny.us/b4kvd3t8

@DrEilidhMaria Higher tendency for staying around where your high reg training is as a consultant. Also can always take it for rent rather than relocation. More sensible than taking it as fuel costs

@DrEilidhMaria May prefer to hold off on using that fund until ST number as that’s a longer duration in a region

@orthotraumamd I’m a draw out my lines on AP and true lateral of head/neck. Skin nick, perc wire to land on my insertion site and either tap it in or if I need adjustment I thread awl over wire. I use Synthes so the honeycomb is only a 4/6 correction so not as useful.

🛠️ Nailing IT Fractures: Starting point is key for optimal implant placement! 🎯 I prefer using an awl for more control compared to just a wire (see image examples below, NOT THE SAME CASE). What are your go-to tricks and tips? Share your techniques! Dive into our latest case @orthobullets : orthobullets.tiny.us/kmarfjct

@DrFraneNicholas @orthotraumamd @dbab1981 @orthobullets @IU_Health @rkh_md @schulte_ss @bonesmith_ @eric_novack @stevemchale @FractureDoc @itius @traumaticum @BrandonYuanMD Very true, an arthroplasty solution for intertroch fractures is doable in some places, but it is not the mainstream option in the UK.

@ChuOrtho @orthotraumamd @dbab1981 @orthobullets @IU_Health @rkh_md @schulte_ss @bonesmith_ @eric_novack @stevemchale @FractureDoc @itius @traumaticum @BrandonYuanMD Converting a DHS to THA is a lot easier than a IMN conversion to THA.

Here is a new case by Dr. Jan Szatkowski @orthotraumamd and @IU_Health. INTERTROCHANTERIC FEMUR FRACTURE IN 75F How would you manage this #orthotwitter? Vote on this case for CME: orthobullets.tiny.us/kmarfjct

@orthotraumamd @dbab1981 @orthobullets @IU_Health @rkh_md @schulte_ss @bonesmith_ @DrFraneNicholas @eric_novack @stevemchale @FractureDoc @itius @traumaticum @BrandonYuanMD Stiff arthritic joint increases the force put through your construct, in places where we do a fair amount of DHS for 2 part fracture, does it justify switching to a on axis construct rather than an off axis construct held on to the shaft by 2-4 large frag screws.

@orthotraumamd @dbab1981 @orthobullets @IU_Health @rkh_md @schulte_ss @bonesmith_ @DrFraneNicholas @eric_novack @stevemchale @FractureDoc @itius @traumaticum @BrandonYuanMD More controversial is what to do in a 2 part intertroch fracture with hip arthritis. DHS or IM Nail, no real literature to guide apart from some application of basic science logic.