Yelena Bogdan, MD, FACS, FAAOS

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@solimanibra92 @DrShivabs @sportsdoc2016 @traumaticum @DrPhilSurface @rkh_md @eric_novack @DrFraneNicholas @bonesmith_ @Gatorgesture1 Parapatellar is totally fine and much better than supra in proximal tibia as the start point is paramount here and much easier to get without the patella in the way. just do a parapatellar, semiextended.

@DrShivabs @InvictaOrtho @sportsdoc2016 @traumaticum @DrPhilSurface @rkh_md @eric_novack @DrFraneNicholas @bonesmith_ @Gatorgesture1 The issue is that I do not have the instrumentation for a suprapatellar tibial nail approach, and no one here has these instruments available

Hello #OrthoTwitter, 50 y/o male with a fracture one year ago. Would you prefer a nail or a plate? What type of plate would be suitable here? @InvictaOrtho @sportsdoc2016 @traumaticum @DrPhilSurface @rkh_md @eric_novack @DrFraneNicholas @bonesmith_ @Gatorgesture1

@solimanibra92 @sportsdoc2016 @traumaticum @DrPhilSurface @rkh_md @eric_novack @DrFraneNicholas @bonesmith_ @Gatorgesture1 Then I think it’s OK. But just make sure that the patients knee has enough range of motion for you to be able to nail and reach the start point. Sometimes the joint next to a nonunion gets really stiff.

@InvictaOrtho @sportsdoc2016 @traumaticum @DrPhilSurface @rkh_md @eric_novack @DrFraneNicholas @bonesmith_ @Gatorgesture1 Yes it was closed and treated by traditional doctor!

@solimanibra92 @sportsdoc2016 @traumaticum @DrPhilSurface @rkh_md @eric_novack @DrFraneNicholas @bonesmith_ @Gatorgesture1 Most likely but depends on how it lines up. Check vitamin D. Assume the fx was closed originally?

@InvictaOrtho @sportsdoc2016 @traumaticum @DrPhilSurface @rkh_md @eric_novack @DrFraneNicholas @bonesmith_ @Gatorgesture1 Thanks Dr Bogdan , With fibular osteotomy and blocking screws?

@MoHasegawa These are Knowles pins! Pain in the butt. Fun fact, they are threaded.

Another SOS. Anybody know these implants? Index procedure in 80’s for SCFE. @traumaticum @jointdocShields @InvictaOrtho @Davembmd Please tag others for help! Haha

@MoHasegawa @traumaticum @jointdocShields @Davembmd No pictures

@Orthopedist12 @traumaticum @DrBhavinJadav Any symptoms at the hip with that screw prominence?

85y old, previous surgery 5y back, what is your plan of fixation? @InvictaOrtho @traumaticum @DrBhavinJadav

@sportsdoc2016 @solimanibra92 @orthotraumamd @generalorthomd

@InvictaOrtho @solimanibra92 @orthotraumamd @generalorthomd Thanks, I always use a long nail in these and interested in techniques to supplement lateral fixation. Guess I’ll need to take that course again!

Healthy 56 yo ski injury. Anyone fixing this? I’m thinking total hip. @InvictaOrtho @orthotraumamd @generalorthomd ##orthotwitter

@sportsdoc2016 @solimanibra92 @orthotraumamd @generalorthomd I actually just did a talk on this that will be presented at the Daily Dilemmas course. Less to do with the torque limiter and more to do with either not using a long nail, or having poor lateral cortex fixation. pubmed.ncbi.nlm.nih.gov/40507724/

@InvictaOrtho @solimanibra92 @orthotraumamd @generalorthomd I use TFNA at one of my hospitals also. Have you had any issues with collapse of the lag screw despite using torque limiter in reverse obliques for instance? I have with TFNA but not Intertan.

@WaaqoMD @DrBhavinJadav @traumaticum @orthotraumamd @centerofhip @vivekortho007 @generalorthomd So based on the CT I saw there isn’t much bone left laterally but you do have medial contact. I would actually nonop this. If it heals, great. If it doesn’t, an arthroplasty will do much better after nonop than after a failed orif if needed.

Greeting colleagues I would appreciate an input on this case 21 yrs old male sustained a GSW to left shoulder with entry and exit wounds. No NV injury @DrBhavinJadav @InvictaOrtho @traumaticum @orthotraumamd @centerofhip @vivekortho007 @generalorthomd

@solimanibra92 @orthotraumamd @sportsdoc2016 @generalorthomd Was not using tfna but right away.

@InvictaOrtho @orthotraumamd @sportsdoc2016 @generalorthomd May I ask Dr. Bogdan, after TFNA..when did you allow him to start weight bearing?

@orthotraumamd @sportsdoc2016 @generalorthomd Not standard at all. I use tfna 99.9% of the time. But. Less shortening, biomechanical/clinical work shows more stability compared to single screw construct. This is highly unstable basicervical in young patient so you want stability and not too much collapse if you’re gonna fix.

@InvictaOrtho @sportsdoc2016 @generalorthomd Why an intertan @InvictaOrtho? Is that your standard construct or is there something about this fracture that makes you lean more towards it?

@Davembmd @AAOS1 I’m sorry! There was a lot going on.

A celeb sighting! Skeletoni made an appearance at our committee meeting to provide support for the OITE🦴💜@AAOS1

@ojedathies The Mardi Gras beads? They are skeletoni’s, but I will not comment on how they were obtained 😜

@InvictaOrtho @AAOS1 Fangirling 100% at a pic of both of you!! Are the pearls yours or skeletoni’s?

An excellent ⁦@AAOS1⁩ OrthoInfo podcast for women who are approaching menopause or have a family member who is. podcasts.apple.com/us/podcast/ort…

@jeremy_dubin Other than advice in the article, my personal opinion is actively practice being humble, and read a lot. That should keep you from most of the problems that are described. And also, accept that if you read, prepared, and did a good job, things can still go wrong.

@InvictaOrtho @InvictaOrtho I am a first year ortho resident. Any advice to best embrace this environment or combat some of the obstacles?

An excellent article for any surgeon or aspiring surgeon.

@InvictaOrtho Ha - I think we just adopted yours!! 🤣

I am a huge proponent of total hip replacement, but unfortunately, anyone who does enough of these will eventually encounter complications … including periprosthetic fracture. Lola is a frequent flier with our service having already had bilateral THRs for luxoid hips, one of which luxated postop requiring revision with a longer neck. However, for almost a year, she had been progressing well! She was back to normal activity and was playing happily with her housemate when she suffered a moderately traumatic fall and became non-weight bearing on the left pelvic limb. Potential reasons for femoral fracture 11 months post THR include stem loosening & subsidence, stress risers at the stem tip, low energy trauma and other patient factors causing reduced bone quality. For Lola, we suspected a combination of the stress riser effect and a medium energy trauma with her associated fall, but ruling out stem loosening would be critical. Radiographs revealed a long oblique periprosthetic left femoral fracture. In humans, periprosthetic fractures are classified via the Vancouver system based upon location - type A are proximal/trochanteric, type B are around the stem, & type C are distal to the stem. Type B fractures are then subclassified based upon stem stability (in B1 the stem is stable while in B2 it is unstable) and amount of bone stock available (for type B3 the stem is loose and there is a paucity of bone stock). Radiographically, we classified Lola’s fracture as a type B1 - although stem stability would still have to be assessed intra-op - and so our plan was to anatomically reduce the fracture and stabilize using cerclage wires and a locking plate and screws. In surgery, we did not detect any stem loosening. This can be difficult to detect, and we did consider luxating the hip to assess this further, but decided against it. Anatomic reduction was achieved and the plate applied to span as much of the femur as possible, but definitely the entire span of the stem. After 12 weeks of rest, the implants remained static and Lola was again progressing well! Now, we work to regain muscle mass and hope this is her last major surgery! #orthopals #msuvets