Nick Pappas MD

@orthobullets @ClevelandClinic @itius @FractureDoc @stevemchale @eric_novack @DrFraneNicholas @bonesmith_ @schulte_ss @robgraymd @sebcyc @centerofhip Distal radius fixation looks good. The Stryker VariAx distal radius plate does make it easier to center the plate thanks to the additional transverse oblong hole. Why did you use threaded screws instead of smooth pegs distally?

Here are intraop & postop images of yesterday's case by Dr. Anokha Padubidri and @ClevelandClinic. DISTAL RADIUS FX WITH CONTRALATERAL FEMORAL SHAFT FX 35M PROCEDURE: 1. Right femur intramedullary nail. 2. Left distal radius fracture open reduction and internal fixation. 3. Left ulna styloid fracture closed treatment. 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/bddpxknr

That neurosurgery residency sure is a long one! Right after you graduate, no one will blame you if you feel you are ready for retirement! All jokes aside, congratulations to all of those who recently graduated! #medicalschool #graduation #funny #medicalstudent #neurosurgeon

@orthobullets @PEvansMDPhD @CleveClinicFL @NickGarbis @DrNickColyvas @surg4shoulders @traumaticum @MDiPaolaMD @eric_novack @Dr_RyanRose @schulte_ss @stevemchale @sancleracot Great button placement right at the anatomic insertion. Thanks for sharing the case!

Here are intraop & postop images of yesterday's case by Dr. Peter J. Evans @PEvansMDPhD and Cleveland Clinic Florida @CleveClinicFL. ACUTE BICEPS RUPTURE IN 41M PROCEDURE: DISTAL BICEPS POSTEROMEDIAL (ANATOMIC) SUTURE BUTTON REPAIR WITH SINGLE ANTERIOR APPROACH 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/mups5aj5

@orthobullets @PEvansMDPhD @CleveClinicFL @Grant_Garrigues @MDiPaolaMD @londonarmdoc @dave_cloke @DrRobHartzler @CowlingSurgeon @NickGarbis @DrNickColyvas @surg4shoulders @Shoulder2LeanOn In a 41 year-old male with a manual type job, I would offer acute repair. Normally I try to do these as soon as possible to avoid further tendon retraction. I favor a one incision technique using a button followed by an interference screw. I allow immediate range of motion.

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

@orthobullets @traumaticum @rkh_md @itius @jamesablairMD @sebcyc @eric_novack @DrFraneNicholas @DrConnos @InvictaOrtho @AmarAPatelMD I think given the fact both fractures are minimally displaced, I would offer a trial of non-operative treatment in a short cast / brace with an x-ray in one week.

Here is a new case by Dr. Maximilian Heitmann and Helios ENDO Clinic Berlin, Medical School Berlin. CAPITATE AND SCAPHOID FRACTURE IN 55F How would you manage this #orthotwitter? Vote on this case for CME: bit.ly/3UNGsBD

@orthobullets @traumaticum @rkh_md @itius @jamesablairMD @sebcyc @eric_novack @DrFraneNicholas @DrConnos @InvictaOrtho @AmarAPatelMD I would favor non-operative treatment with close follow up.

@orthobullets @MarkVitaleMD @ONSMD @robgraymd @itius @handsurgortho @ColJacksMed @MrAlexNicholls @orthohand @Dr_RyanRose @MarvinDingleMD @OrthopedicsMD @anilbhatortho If you have access, CCH has become a common initial treatment for this condition, with pretty good results in my experience. Needle aponeurotomy would be another option, but I don't like to do that in the PIP joint region due to proximity to the neurovascular bundle.

Here is a new case by Dr. @MarkVitaleMD and Orthopaedic & Neurosurgery Specialists (@ONSMD). RING FINGER FLEXION CONTRACTURE IN 64M How would you manage this #orthotwitter? Vote on this case for CME: orthobullets.tiny.us/3tuw389m

Who is ready for a surgical residency? Just to clarify, these quotes weren’t all said to me, and many were said in jest…but not all 😂 Make sure you have a thick skin if you do a surgical residency. #surgerylife #residency #inspirationalquotes #quotes #residencylife

@orthobullets @drbadia @robgraymd @ReedHoyerMD @JohnDunnMD @orthohand @Dr_RyanRose @OrrinFrankoMD @ShamimUmarji @MarvinDingleMD @DrConnos @anilbhatortho Board-certified hand surgeon here. Tough case for sure. At five weeks out, I would give her the option for an osteotomy, especially if angular deformity lead to significant crossover with fist formation.

Here is a new case by Dr. Alejandro Badia (@drbadia) and Badia Hand to Shoulder Center. PROXIMAL INTERPHALANGEAL ANGULAR DEFORMITY IN 16F How would you manage this #orthotwitter? Vote on this case for CME: orthobullets.tiny.us/yckmnyc3

Knee replacements generally do very well #Knee #Arthritis #KneeReplaceme... youtube.com/shorts/USpkA2M… via @YouTube

@orthobullets Non-operative in a DIP extension splint. You only really need to operate on these if there is DIP joint volar subluxation

How would manage this injury?

Here is a new case by Dr. Robert Ruth from @Assoc_Hand_Surg., Santa Barbara, CA. BONY MALLET FRACTURE IN 28M How would you manage this #orthotwitter? Vote on this case for CME: orthobullets.tiny.us/2p9yfzey

@orthobullets Non-operative in a DIP extension splint. You only really need to operate on these if there is DIP joint volar subluxation

HPI: Patient is a 28-year-old, right-hand-dominant male who injured his left small finger while rock climbing in a gym. He recalls impacting his left small finger while reaching overhead with his finger in extension. The patient sustained a small abrasion at the left small finger dorsal DIP joint but the fracture remained closed. PMH: Patient otherwise in good health. No medications. PE: Examination of the left small finger reveals swelling over the dorsal DIP joint region but no wounds at that level. Mild ecchymosis underneath the dorsal nail roof and proximal nail plate. The nail plate is present. Distal neurovascular status is intact. DIP joint extensor lag of 5 degrees or less. The collateral ligaments are stable. Some tenderness at the dorsal DIP and dorsal PIP joint. No PIP joint instability. Motion was not tested due to known fracture.

@fallguy24845048 @orthobullets @traumaticum @rkh_md @EauClaireOrtho @PaulSethiMD @FractureDoc @stevemchale @DrFraneNicholas @itius @DeformityDoc @rish_parmar He had limited elbow range of motion

@orthobullets @traumaticum @rkh_md @EauClaireOrtho @PaulSethiMD @FractureDoc @stevemchale @DrFraneNicholas @itius @DeformityDoc @rish_parmar Examine him. Possibly Local to check rotation. If able to fully sup/pronate would discuss pros and cons of conservative vs replacement. If block to rotation more inclined to surgery

Here is a new case by Dr. Nick Pappas and NOLA Hand Surgery. RADIAL HEAD FRACTURE IN 41M How would you manage this #orthotwitter? Vote on this case for CME: orthobullets.tiny.us/yckp9dvt

@rkh_md @orthotraumamd @orthobullets @traumaticum @EauClaireOrtho @PaulSethiMD @FractureDoc @stevemchale @DrFraneNicholas @itius @DeformityDoc @rish_parmar That is certainly a concern, but his radial head was very fragmented

@orthotraumamd @orthobullets @traumaticum @EauClaireOrtho @PaulSethiMD @FractureDoc @stevemchale @DrFraneNicholas @itius @DeformityDoc @rish_parmar 41 is sooooooo young.

@agrawal966 @orthobullets @traumaticum @rkh_md @EauClaireOrtho @PaulSethiMD @FractureDoc @stevemchale @DrFraneNicholas @itius @DeformityDoc @rish_parmar What would you do for the radial neck split?

@orthobullets @traumaticum @rkh_md @EauClaireOrtho @PaulSethiMD @FractureDoc @stevemchale @DrFraneNicholas @itius @DeformityDoc @rish_parmar Straight forward case of Radial Head Replacement. Pretty comminuted fracture, cannot fix it by any means.

@itius @orthobullets @traumaticum @rkh_md @EauClaireOrtho @PaulSethiMD @FractureDoc @stevemchale @DrFraneNicholas @DeformityDoc @rish_parmar That was a real fracture line

@orthobullets @traumaticum @rkh_md @EauClaireOrtho @PaulSethiMD @FractureDoc @stevemchale @DrFraneNicholas @DeformityDoc @rish_parmar I need to see more slides There’s a line in metaphyseal that could be a line (maybe my eyes) I always try tripod screws ORIF but most likely I’d have the radial head replacement in the room

@orthotraumamd @orthobullets If the radius were just shortened but the volar tilt was OK

@NickPappasMD @orthobullets When are you doing an ulna shortening osteotomy?

Here is a new case by Dr. Surendra Shetty. DISTAL RADIUS MALUNION IN 55M How would you manage this #orthotwitter? Vote on this case for CME: orthobullets.tiny.us/4sk2ynzf