Derek Moore, MD

I wanted to see how good the AI is reading xrays. I uploaded this Xray and gave this prompt: What is the Anderson Orthopaedic Research Institute (AORI) Classification? What do people think of the response. Femur: AORI Type 1 – metaphyseal bone stock globally preserved, intact cortical rims, no large cavitary or segmental defects; long cemented stem not clearly bridging a major metaphyseal void. Tibia: AORI Type 2A – proximal metaphyseal bone loss predominantly on one side with thinning/osteolysis, but overall cortical rim preserved and remaining metaphyseal bone capable of supporting a stemmed component. Overall: AORI femur 1 / tibia 2A, based on AP view only; final classification subject to confirmation with lateral and intra-operative findings. #orthotwitter, Would you agree with this assessment?

Here is a new case by Dr. Andrea Baldini and IFCA Institute. KNEE PAIN AND INSTABILITY S/P TKA IN 75M This case will be discussed at the THE Revision Knee Meeting 2026 in Antwerp, Belgium, Jan 29-30, 2026. How would you manage this #orthotwitter? Vote on this case for CME: orthobullets.tiny.us/ybczf3kr

@itius @orthobullets @Nemours @traumaticum @anklefootmd @FootAndAnkleMD @Vishal21975 @Drlyndonmason @DrAJ26001405 @DrFraneNicholas @clareau @ChrisWi19030624 @southNJscoli "External rotation stress test showing stability of the syndesmosis (no significant widening of the medial clear space or the distal tib/fib joint, when compared to contralateral)"

@orthobullets @Nemours @traumaticum @anklefootmd @FootAndAnkleMD @Vishal21975 @Drlyndonmason @DrAJ26001405 @DrFraneNicholas @clareau @ChrisWi19030624 @southNJscoli May I ask if syndesmosis was stable? I’d thought that a syndesmosis screw were needed

Here are intraop & postop images of yesterday's case by Dr. Rachel Silverstein, Anna Rambo, and Moawiah Mustafa from @Nemours Children’s Health. ANKLE FRACTURE IN 16M PROCEDURE: ORIF LEFT ANKLE 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/bdhhdpbc

Unfortunately we made a copy/paste mistake on a key image when posting today. . Where we talked about a CT scan of cervical spine, it was meant to say: "External rotation stress test showing stability of the syndesmosis (no significant widening of the medial clear space or the distal tib/fib joint, when compared to contralateral)" Here is the corrected image. Important for this case.

@jointdocShields @orthobullets @HMethodistMD @BennerKneeMD @MrSimonTalbot @txsportsdoc @centerofhip @huddleston_md @generalorthomd @KevinParkMD @bonesmith_ @drgsreddy lol - ya lets talk infection prevention. if this patient had a prior intra-articular steroid injection, how long would you wait prior to proceeding with a TKA?

@orthobullets @HMethodistMD @BennerKneeMD @MrSimonTalbot @txsportsdoc @centerofhip @huddleston_md @generalorthomd @KevinParkMD @bonesmith_ @drgsreddy This feels like a trick question TKA

Here is a new case by Dr. Colin McNamara. This case is sponsored by Houston Methodist Orthopedics & Sports Medicine @HMethodistMD. KNEE PAIN IN 69F WITH RHEUMATOID ARTHRITIS How would you manage this #orthotwitter? Vote on this case for CME: orthobullets.tiny.us/yc6wn66j

@BennerKneeMD @orthobullets @DanielLiechtiMD @emplifyttown @RachelFrankMD @Lafi_KhalilMD @DrBryanSaltzman @txsportsdoc @schulte_ss @DrDerekOchiai @MDMillerMDUVA @BenMayoMD @H2O_SportsMD Rodney, why have you stuck with the inside out repairs and not use the all inside devices?

@orthobullets @DanielLiechtiMD @emplifyttown @RachelFrankMD @Lafi_KhalilMD @DrBryanSaltzman @txsportsdoc @schulte_ss @DrDerekOchiai @MDMillerMDUVA @BenMayoMD @H2O_SportsMD In a 27 yo with no previous symptoms and an acute locked medial bucket and an intact ACL, this is one I would probably repair. Inside-out sutures and immediate weightbearing to tolerance without ROM restriction. I will say, I find the situation as described to be pretty rare.

Here is a new case by Dr. Daniel Liechti @DanielLiechtiMD and Emplify Health Titletown Sports Medicine and Orthopedics @emplifyttown. PAINFUL "LOCKED" KNEE IN 27M How would you manage this #orthotwitter? Vote on this case for CME: orthobullets.tiny.us/syptrwcp

@MDMillerMDUVA @orthobullets @DanielLiechtiMD @emplifyttown @RachelFrankMD @Lafi_KhalilMD @DrBryanSaltzman @txsportsdoc @schulte_ss @DrDerekOchiai @BenMayoMD @H2O_SportsMD @BennerKneeMD it sounds like you continue to do inside out repairs? Did you ever adopt the all inside repair gadgets? Also, when you do an inside-out repair, are you making safety incision?

@Derekwmooremd @orthobullets @DanielLiechtiMD @emplifyttown @RachelFrankMD @Lafi_KhalilMD @DrBryanSaltzman @txsportsdoc @schulte_ss @DrDerekOchiai @BenMayoMD @H2O_SportsMD @BennerKneeMD The sooner the better because of possible damage to meniscus and development of a flexion contracture. Not emergent but first opportunity (within a few days).

@MDMillerMDUVA @orthobullets @DanielLiechtiMD @emplifyttown @RachelFrankMD @Lafi_KhalilMD @DrBryanSaltzman @txsportsdoc @schulte_ss @DrDerekOchiai @BenMayoMD @H2O_SportsMD @BennerKneeMD Mark, thanks for the great comment. When you say early operative repair, how early do you mean? Considering the knee is locked in flexion, and you already have an MRI, would you take him to surgery urgently the same day or is within a few days OK?

@orthobullets @DanielLiechtiMD @emplifyttown @RachelFrankMD @Lafi_KhalilMD @DrBryanSaltzman @txsportsdoc @schulte_ss @DrDerekOchiai @BenMayoMD @H2O_SportsMD @BennerKneeMD Classic bucket handle tear of the medial meniscus. A few teaching points: 1. Exam: Beware of false endpoint on Lachman. Displaced bucket can sometimes block excursion. 2. MRI: Note Double PCL sign on Sagittal. 3. Mandatory repair early! Inside-out vertical mattress sutures

Does anybody know any other good studies looking at femoral neck fractures in patients on anticoagulants - to delay or not to delay? Upcoming journal club. pubmed.ncbi.nlm.nih.gov/32164755/

@orthobullets @PEvansMDPhD @CleveClinicFL @Grant_Garrigues @MDiPaolaMD @londonarmdoc @dave_cloke @DrRobHartzler @CowlingSurgeon @NickGarbis @DrNickColyvas @surg4shoulders @Shoulder2LeanOn Here is the only article on distal biceps ruptures that was included in ABOS WLA. They found "Distal biceps repair is associated with a 7.5% major complication rate and 4.5% reoperation rate." Is this consistent with everyone's experience? pubmed.ncbi.nlm.nih.gov/30139681/

Here is a new case by Dr. Peter J. Evans @PEvansMDPhD and Cleveland Clinic Florida @CleveClinicFL. ACUTE BICEPS RUPTURE IN 41M How would you manage this #orthotwitter? Vote on this case for CME: orthobullets.tiny.us/mups5aj5

I agree, the end goal is “patient care”excellence. But in my opinion, the most important way to optimize good patient care is to create a happy, content career. To do that, you need to learn smart, not hard. A medical student spending the night in the hospital is low educational value. Instead they should be at home and get “called in” if a unique educational opportunity presents itself.

Excellence is largely a function of accumulated and compounded experience. Learning is not linear, it has an exponential curve and the more experiences one can have early in training the more you have to build upon. If the end goal is excellence than any potential opportunity for additional experience is in alignment. If the end goal is getting by, then, I suppose this mindset will work.

@AleksiReito As you can see, this patient had an excellent result. I don't know how long it will last, and there could be a lot of other variables as to why there was a delta improvement from pre-op to post-op. Question for you: when applying the literature, how do you accommodate the outliers, the individual patient factors, and the fact that there are always 1 in 10,000 that have an "outlier" outcome? As a spine surgeon, I have the sad situation of often being the first to diagnose metastatic cancer with lesions to the spine. For these patients, I would never say the literature says there is no hope and you are going to die. I say there are always exceptions; there are clear examples of "miracle cancer survivors." While you have to be realistic for family planning reasons, you also have to "believe" that there is a chance that you will be the "one miracle survivor." Clinical studies apply "averages" to individuals. Patient care needs to be tailored to the individual. I am not saying don't follow the evidence and literature, I am just saying that following it alone is not the whole solution for being a good "healer".

Here are postop images and a clinical video of yesterday's case by Dr. Stephen Incavo (@StephenJIncavo) and Houston Methodist Orthopedics & Sports Medicine (@HMethodistMD). HIP PAIN AND LIMP IN 78F PROCEDURE: GLUTEUS MEDIUS/MINIMUS REPAIR + GLUTEUS MAXIMUS TRANSFER Here is the link to the clinical presentation and the pre-op imaging: orthobullets.tiny.us/0020924 Click here to view an intraoperative video showing the steps of the gluteus medius repair: orthobullets.tiny.us/incavo-intraop 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/2p98hpy4

That is my point. It sounds like you are a strong scientist with experience in research and publishing. So it is easy for you to filter out what can be trusted and what can not be. For guys like me, without a strong background in statistics, it isn't very easy to know what to trust. Couple that with the fact that the journal and the scientific publication industry are essentially a "pay for self-promotion and marketing yourself and your hospital" enterprise; the vast majority of published material is low quality and not to be trusted.

@Derekwmooremd @orthobullets @StephenJIncavo @HMethodistMD @drsebheaven @ChrisGraysonMD1 @tdd340 @jointdocShields @yoon_rs @schulte_ss @DrFraneNicholas @stevemchale @itius @KevinParkMD Can you show a preclinical study which supports tendon repair in 78 yr olds? UKUFF trial shows 40% retear rate. That review consists of before-after studies. No control group and big lost to follow-up. You really can't use that for decision making. pubmed.ncbi.nlm.nih.gov/23401563/

Here is a new case by Dr. Stephen Incavo (@StephenJIncavo) and Houston Methodist Orthopedics & Sports Medicine (@HMethodistMD). HIP PAIN AND LIMP IN 78F How would you manage this #orthotwitter? Vote on this case for CME: orthobullets.tiny.us/2p98hpy4

@KevinParkMD are you at a point where you think steroid injections for the presumed diagnosis of trochanteric bursitis should be avoided until after an MRI is done and confirms that there is not an underlying abductor tendon tear and that the pathology is in the trochanteric bursa?

@jointdocShields @orthotraumamd @orthobullets @StephenJIncavo @HMethodistMD @drsebheaven @ChrisGraysonMD1 @tdd340 @yoon_rs @schulte_ss @DrFraneNicholas @stevemchale @itius @shaunpat1 My patients who are referred to me commonly have history of multiple troch injections some every 3 months and some every month….

@KevinParkMD @orthotraumamd @orthobullets @StephenJIncavo @HMethodistMD @drsebheaven @ChrisGraysonMD1 @tdd340 @jointdocShields @yoon_rs @schulte_ss @DrFraneNicholas @stevemchale @itius @shaunpat1 @KevinParkMD How often have you gone back in months later to repair a abductor tear in a hip fx s/p CMN?

@orthotraumamd @orthobullets @StephenJIncavo @HMethodistMD @drsebheaven @ChrisGraysonMD1 @tdd340 @jointdocShields @yoon_rs @schulte_ss @DrFraneNicholas @stevemchale @itius @shaunpat1 Not very often. They usually have host of other problems such as further fragility fractures, leg length discrepancy from the fracture, etc. symptomatic abductor tendon tears are usually low on the list

@AleksiReito @orthobullets @StephenJIncavo @HMethodistMD @drsebheaven @ChrisGraysonMD1 @tdd340 @jointdocShields @yoon_rs @schulte_ss @DrFraneNicholas @stevemchale @itius @KevinParkMD I think the real question is - what is the liklihood they heal? Do we need a RoHI index score for hip abductor tears? pmc.ncbi.nlm.nih.gov/articles/PMC10…

@orthobullets @StephenJIncavo @HMethodistMD @drsebheaven @ChrisGraysonMD1 @tdd340 @jointdocShields @yoon_rs @schulte_ss @DrFraneNicholas @stevemchale @itius @KevinParkMD Tendon repair in 78 year old? They don't succeed even in 60 year old patients. Tendon regeneration stops at age 17. Sometimes I can't stop wondering how our field ignores research on basic biology and the natural history of diseases.

@orthobullets @atmghn A.T, how are you tackling these in Switzerland these days? Navigation? Expandable cages?

If you choose PSIF + TLIF, what type of interbody implant would you utilize?

Here are postop images of yesterday's case by Dr. @AliBaajMD and Sananthan Sivakanthan from @BannerHealth. LEG AND BUTTOCK PAIN IN 65M PROCEDURE: L4/5 MIS TLIF Here is the link to the clinical presentation and the pre-op imaging: orthobullets.tiny.us/0126255 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/2p92uayd

@orthobullets @AliBaajMD @BannerHealth @atmghn @AmitJainSpine @KhoiThanMD @drericksonspine @SpineNeuro @thejuansuribe @MichaelYangMD @geofreyngetich @JohnHShinMD @AliBaajMD, what are you doing in the intervertebral space? Anything special to prepare the endplates like microfracture holes? BMP? DBM? Local bone from the pars resection if you did one?

@orthobullets @AliBaajMD @drmikeselby What are the key questions you ask DS patients to understand how the neurogenic claudication is impacting their lives? How many epidural injections do you do before you call it quits and proceed with surgery?

This is a great basic teaching case. In terms of doing the operation, there are many different options, and the discussion falls under the bucket of “there are many ways to skin the cat." I think the more important discussion is when to offer surgery versus continuing with nonoperative management. As somebody who’s had one hip replaced already, and what I've learned from the arthroplasty literature, the treatment of degenerate spondylolisthesis and neurogenic claudication should really be focused on improving walking enjoyment and duration. The key questions to ask his patient are things like: Do you no longer play golf like you used to because of pain in your buttocks? Have you stopped walking with friends due to pain in your buttocks that makes you want to sit down? Do you enjoy shopping or is it an unpleasant experience because you always want to sit down?

Here is a new case by Dr. @AliBaajMD and Sananthan Sivakanthan from @BannerHealth. LEG AND BUTTOCK PAIN IN 65M How would you manage this #orthotwitter? Vote on this case for CME: orthobullets.tiny.us/2p92uayd