Yelena Bogdan, MD, FACS, FAAOS

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@traumaticum @sancleracot @orthotraumamd @Gnomelover1970 I’m a little concerned about your idea of fun🤣

@sancleracot @InvictaOrtho @orthotraumamd @Gnomelover1970 Agree with nonop but these ARE fun to plate. Well tolerated op with minimal postop pain, full AROM and no brace. Sling for comfort.

Male 50yo Any chance of nonop management? Perfect alignment in all x-rays views but what about this gap? @InvictaOrtho @traumaticum @orthotraumamd @Gnomelover1970 #orthotwitter

@solimanibra92 @bonesmith_ @traumaticum @centerofhip @TJimulia @neilorpen @sportsdoc2016 @ojedathies @itius DHS is weightbearing.

@InvictaOrtho @bonesmith_ @traumaticum @centerofhip @TJimulia @neilorpen @sportsdoc2016 @ojedathies @itius Thanks doctor Bogdan I will use a two-hole plate. Should I allow immediate weight bearing as tolerated after surgery?

Hello #OrthoTwitter 👋 25 male, post RTA. PFN or DHS? It’s quite rare for me to see a fracture like this in a patient this young If PFN: What is the proper entry point ? @InvictaOrtho @bonesmith_ @traumaticum @centerofhip @TJimulia @neilorpen @sportsdoc2016 @ojedathies @itius

@txsportsdoc I am no longer an aaos social media ambassador but will pass on

Private practice orthos face challenges recruiting. Smaller private practices are having to spend thousands and compete with large systems and PE groups for simply posting a job position which many of our colleagues may want to consider. This feels like another hit against us private practices. @AAOS1 has done a lot of good things recently to add value to being a member. AAOS is using MedGeo Ventures, LLC to post jobs on their platform. It’s expensive and favors large institutions and PE groups. If you have multiple locations, you are penalized for this. I’d like to see our academy own recruitment. Make it easy and affordable, for private practices to post jobs so our colleagues can connect. I think it should be free for members, or much more affordable to post. If systems want to post, then charge them a corporate rate. I hope my AAOS ambassadors will support this. @djschuett @jointdocShields @InvictaOrtho @Davembmd @That_AjKid @CenterRotation @AmitMomayaMD @SethLShermanMD

@medflutter_ @sportsdoc2016 @Davembmd @traumaticum @orthotraumamd BHN theory posits that all nonunion problems are stability problems. Therefore, increasing stability will heal pretty much every non-union. This is a minimally invasive increase in stability. I replied to somebody else with a paper on percutaneous strain reduction screws

@sportsdoc2016 @Davembmd @traumaticum @InvictaOrtho @orthotraumamd Can you explain this a Bit further?

Want to give follow up and thanks to @traumaticum @InvictaOrtho @orthotraumamd and sorry if I missed others who recommended strain reduction screws for this nonunion. Was open segmental fracture in 39 yo electrical lineman. Took a year but finally got him healed.

@drArif_Bd @sportsdoc2016 @Davembmd @traumaticum @orthotraumamd pubmed.ncbi.nlm.nih.gov/30893223/ There are others, search for “percutaneous strain reduction screws” on pubmed

@sportsdoc2016 @Davembmd @traumaticum @InvictaOrtho @orthotraumamd Any paper regarding this technique @traumaticum @InvictaOrtho @orthotraumamd

@solimanibra92 @bonesmith_ @eric_novack @neilorpen @sportsdoc2016 @traumaticum @txsportsdoc The two reasons to fix a patella are prevention of posttraumatic arthritis, and preservation of knee extension. If his knee doesn’t move at all and it is fixed in extension and he is walking, neither of those two factors seem to apply. We treat patients, not x-rays…

Hello #OrthoTwitter, 55 y/o M a femoral fracture treated 20 years ago. He presented after a fall 4 days ago for plate removal. He has had no knee flexion for the past 20 years (fixed in extension). Would you address the patella or leave it as is? @InvictaOrtho @bonesmith_

@traumaticum @solimanibra92 @Gnomelover1970 @bonesmith_ @centerofhip @sportsdoc2016 I like how we both used red and both pointed to pretty much the same place😆

@solimanibra92 @InvictaOrtho @Gnomelover1970 @bonesmith_ @centerofhip @sportsdoc2016

Hello #OrthoTwitter In this # pattern, how do you determine the PFN entry point when the greater trochanter is fractured at the usual entry site? Or would a plate be a better option in this case? @traumaticum @InvictaOrtho @Gnomelover1970 @bonesmith_ @centerofhip @sportsdoc2016

@solimanibra92 @traumaticum @Gnomelover1970 @bonesmith_ @centerofhip @sportsdoc2016 Red mark

@InvictaOrtho @traumaticum @Gnomelover1970 @bonesmith_ @centerofhip @sportsdoc2016 Like this or more medial dr Bogdan?

@solimanibra92 @DrShivabs @traumaticum @Gnomelover1970 @bonesmith_ @centerofhip @sportsdoc2016 Absolutely not. You can do short for an IT but this is not just an IT. multiple studies (clinical and biomechanical) show a limit of 3cm extension (my personal is 2.5cm generally) below the lesser. This is far more than that.

@DrShivabs @traumaticum @InvictaOrtho @Gnomelover1970 @bonesmith_ @centerofhip @sportsdoc2016 pmc.ncbi.nlm.nih.gov/articles/PMC50…

The hardest working ⁦@AAOS1⁩ committee! (But of course I’m biased)❤️

@generalorthomd Yup my hospital requires both bls and acls. I think it’s ridiculous. Bls sure, just for “Good Samaritan” purposes in real life. But there is no scenario in a hospital where an ortho attending is, or should be, doing acls.

US Orthopedic Surgeons: Are you required to maintain ACLS certification?

@sportsdoc2016 @traumaticum @orthotraumamd Make sure you have a good start point and that the nail isn’t buried too deep pubmed.ncbi.nlm.nih.gov/40507724/

Planning a long nail for this but have been burned in past with collapse using TFNA. Any tips/recs to prevent collapse? Locking set screw has been ineffective. @InvictaOrtho @traumaticum @orthotraumamd #orthotwitter

@FractureDoc @traumaticum Nice. Maybe when ppl refer to load bearing or sharing they are thinking of “ideally placed” construct. But truth is a spectrum, like other controversies…Is distal femur plate a bridge, a neutralization if 1 screw added etc. I never liked labels. I think of it as “what bone does”

So, the whole Nail = load sharing & plate = has always seemed like b.s. to me but I never saw it written anywhere (maybe I just couldn’t find). So I wrote it (w/LS). Generations of residents (& attendings) have parroted this. No more.

@northwoods1980 Poor reduction. Nail still has to be ORIF, not OIF to work.

Next...

Patient is massive. But, curious how others would interpret this.

@northwoods1980 *taps sign* Unstable fx pattern (reverse oblique variant) = no hip screw.

@northwoods1980 Now, if anyone operates on me, I just tell them, do what you would normally do, use the protocol that works for you and do not deviate. But if I know there will be residents or fellows, I request close supervision and not just “alright you do this case, see ya.”

@northwoods1980 That said the 2 times I specifically requested attending, I had complications. Lol. For my 1st pregnancy, an attending stuck me 4 times!! for epidural. Worst pain I’ve ever felt and it ended up not working. For the 2nd baby, it was a fellow, young woman. Did it in 2 sec painless

My younger brother just canceled his son's surgery for thyroglossal duct cyst removal. He had specifically requested only the attending surgeon perform it but then found out multiple cases were being run simultaneously and a fellow was actually going to be doing it. Thoughts?