Raffy Mirzayan, M.D.

@orthobullets @KPSCALnews @rkh_md @DrMarecek @DeformityDoc @jamesablairMD @FractureDoc @stevemchale @traumaticum @DrFraneNicholas I am concerned about the +Fleck/flake sign.  Get MRI or ultrasound to rule out a triceps rupture.  If torn, I would perform ORIF and Triceps repair, after restoring the underlying metabolic issues.  If the triceps is not torn, then would treat non-operatively.

Here is a new case by Dr. Neil Sardesai and Kaiser Permanente (@KPSCALnews). ISOLATED PROXIMAL ULNA FRACTURE IN 43M How would you manage this #orthotwitter? Vote on this case for CME: orthobullets.tiny.us/yc6pfttx

@orthobullets @drchrisahmad @ColumbiaMed @AnthonyRomeoMD @PaulSethiMD @H2O_SportsMD @Grant_Garrigues @DrRobHartzler @rish_parmar @DrNMaassen @OrthoStrelzow @pmacdonald16 @EauClaireOrtho I have been using a single tunnel, suspensory fixation on both the ulnar and humeral sides. I get patients moving faster in PT. In our series, patients returned to pitching in a game at a mean of 9 months.

Here is a new case by Dr. Christopher Ahmad (@drchrisahmad) and Columbia University Medical Center (@ColumbiaMed). ELBOW MUCL INJURY IN 19M PITCHER This case will be debated at the 2023 Baseball Sports Medicine: Game-Changing Concepts in New York City, New York, November 16-17, 2023. How would you manage this #orthotwitter? Vote on this case for CME: orthobullets.tiny.us/4ktbw23c

@orthobullets @drchrisahmad @ColumbiaMed @AnthonyRomeoMD @PaulSethiMD @H2O_SportsMD @Grant_Garrigues @DrRobHartzler @rish_parmar @DrNMaassen @OrthoStrelzow @pmacdonald16 @EauClaireOrtho appears to be an acute on chronic case. I would suture the ligament and tug on it. if the sutures rip out of the ligament, I would do a reconstruction with an ipsilateral palmaris longus graft.  If the suture holds, I would do a repair +IB.  I would leave the ulnar nerve alone

@orthobullets @traumaticum @rkh_md @EauClaireOrtho @PaulSethiMD @FractureDoc @stevemchale @DrFraneNicholas @itius @DeformityDoc @rish_parmar I would caution against using a bipolar implants in terrible triads. Also, do not overstuff joint with too high of an implant (length) but also too large of a head diameter implant (width). In our study, a A 26-mm head had 7.7 odds of revision compared to a size 18-mm head.

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

@orthobullets @traumaticum @rkh_md @EauClaireOrtho @PaulSethiMD @FractureDoc @stevemchale @DrFraneNicholas @itius @DeformityDoc @rish_parmar In a non-triad case, r/o (Essex-Lopresti) also valgus stability. 54% of isolated radial head fractures have a torn UCL. In these cases, radial head resection would lead to chronic valgus instability. So if you want to do a resection, check the UCL first under fluoroscopy.

@orthobullets @AceShoulderMD @KPSCALnews @AnthonyRomeoMD @JonBarlowMD @ReedHoyerMD @rish_parmar @DrRobHartzler @RachelFrankMD @EauClaireOrtho @MDiPaolaMD @sportsdoc2016 @txsportsdoc "Another Banger!" Nicely demonstrated. Been using Double Suspensory technique since 2011. RTP at 9 months versus 12 months with most other techniques. Prefer Ipsilateral palmaris, then contralateral PL, then allograft. In pros, autograft only. Leave nerve alone!

Here is a new case by Dr. Daniel Acevedo (@AceShoulderMD) and Kaiser Permanente (@KPSCALnews). ELBOW MUCL RECONSTRUCTION IN 19M How would you manage this #orthotwitter? Vote on this case for CME: orthobullets.tiny.us/53whafpf

@orthobullets @Grant_Garrigues @MOR_Docs @JSanchezSotelo @JonBarlowMD @H2O_SportsMD @Okwenze @OrthoStrelzow @ReedHoyerMD @joshdinesmd @shoulderMD @rish_parmar @DrRobHartzler of grafts in the humeral head over using screws- (personal preference).

Here is a new case by Dr. @Grant_Garrigues & Midwest Orthopaedics at RUSH (@MOR_Docs). ANTERIOR LEFT SHOULDER INSTABILITY WITH BIPOLAR BONE LOSS IN 38F This case will be debated at the 2023 Critical Concepts in Shoulder & Elbow Surgery in Las Vegas, Nevada, Nov 2-4, 2023. How would you manage this #orthotwitter? Vote on this case for CME: orthobullets.tiny.us/y5jfdnb9

@orthobullets @Grant_Garrigues @MOR_Docs @JSanchezSotelo @JonBarlowMD @H2O_SportsMD @Okwenze @OrthoStrelzow @ReedHoyerMD @joshdinesmd @shoulderMD @rish_parmar @DrRobHartzler With extreme external rotation, the Hill-Sachs can be exposed. I use fresh lateral femoral condyle for big lesions like this, because they are more readily available over humeral head grafts. The radius of curvature of LFC matches perfectly with DTA. I prefer press fit fixation

@orthobullets @Grant_Garrigues @MOR_Docs @JSanchezSotelo @JonBarlowMD @H2O_SportsMD @Okwenze @OrthoStrelzow @ReedHoyerMD @joshdinesmd @shoulderMD @rish_parmar @DrRobHartzler I would wait at least 6 months until seizure is controlled or longer if at all possible. I prefer bony reconstruction in seizure patients over soft tissue repair. I would do an open anterior approach with subscapularis tenotomy. I would do a fresh DTA with button/suture fixation

Join me at the inaugural @PinnacleMeeting in Bend, OR. Course directors @PatrickDenardMD and Brad Parsons have brought together an all-star shoulder faculty and put together a amazing agenda. Add to that the incredible location, and it’s sure to be a hit!

@orthobullets @nyulangoneortho @BillLevineMD @JonBarlowMD @ReedHoyerMD @drcharlesjobin @Grant_Garrigues @rish_parmar @AliNoorani1 @lbowfixr @drs462 @DomosPeter Great case Joe. I would also do a single stage revision to RTSA .

Here is a new case by Dr. Joseph Zuckerman and @nyulangoneortho. PAIN AFTER ANATOMIC TOTAL SHOULDER ARTHROPLASTY IN 66F This case will be debated at the 2023 New York Shoulder Arthroplasty Course in New York, NY, May 19-20, 2023. How would you manage this #orthotwitter? Vote on this case for CME: orthobullets.tiny.us/m6nwdhrs

Preliminary Outcomes of Arthroscopic Biologic Tuberoplasty in the Treatment of Massive Irreparable Rotator Cuff Tears cureus.com/articles/12910…

@orthobullets @IU_Health @PaulSethiMD @ReedHoyerMD @Grant_Garrigues @CowlingSurgeon @umasrikumaran @DrRobHartzler @JonBarlowMD @dave_cloke @MDiPaolaMD @Dr_RyanRose I use a single cannulated partially threaded screw when I do an olecranon osteotomy or for traction apophysitis. For displaced fractures such as this one, pre-contoured plates are my go to. I think low profile double plating may be a viable option with less prominence of hardware

Here’s a new case by Dr. Jacob Triplet and @IU_Health, Ball Memorial Hospital. OLECRANON FRACTURE IN 67F How would you manage this #orthotwitter? Vote on this case for CME: orthobullets.tiny.us/yckzubk7

Join me in Arizona (or via livestream) on Feb. 2-4 for Comprehensive Shoulder & Elbow Course! Our outstanding faculty provide updates on the latest treatment options for shoulder & elbow arthroplasty, arthroscopy, fracture & reconstruction. mayocl.in/3AHSSRA

@orthobullets @IU_Health @JSanchezSotelo @Grant_Garrigues @PaulSethiMD @BillLevineMD @AnthonyRomeoMD @BrianColeMD @MDMillerMDUVA @DrNikhilVerma @RDShoulder @H2O_SportsMD Agree with most have said. I would have done an SCR given there was no lag sign, but LTT is also a great option. Well done JSS!

Here’s a new case by Dr. Jacob Triplet from @IU_Health Irreparable Rotator Cuff Tear in 53M How would you manage this #orthotwitter? Case details: orthobullets.tiny.us/ycxduksr @JSanchezSotelo will debate this case at Critical Concepts in S&E Surgery Meeting, Las Vegas, Oct 13-15.

New expert video by @EvanLedermanmd @BannerHealth presented @shoulder360. "3 Things I Retained from Training and 3 Things I Have Abandoned" Speaker: Evan Lederman, MD Click here to watch the full video: orthobullets.tiny.us/2s4z8u3p

@orthobullets @EvanLedermanmd @BannerHealth @shoulder360 Excellent presentation @EvanLedermanmd

@orthobullets @RothmanOrtho @orthotraumamd @MikeKnudsenMD @InvictaOrtho @FractureDoc @PaulSethiMD @BrianColeMD @JSanchezSotelo @traumaticum @jamesablairMD Having trained at LAC+USC where Sarmiento was a former chairman, most were treated non-op. Up to 30 degrees (varus/valgus) angulation is acceptable. The only time we fixed these were for polytrauma, open fractures, vascular injuries that had to be repaired.

Here’s a new case by Dr. Joseph Abboud from @RothmanOrtho about a Distal Humeral Shaft Fracture in 22F (details in thread below), which will be debated at MASES 2022. How would you manage this? Share your insights with the #orthotwitter community! orthobullets.tiny.us/44saecvk

Congrats to @PaulSethiMD, Dr. Abboud, and Dr. Mirzayan @vegascourse on their inaugural @shoulder360 Course in Miami! A new approach to peer education!   #ASES #Shoulder360 #Ortho

The Nice Shoulder course is half the price for Fellows (600€) for the 3 days and is including: - welcome cocktail - breakfast - Lunch - Free Workshops to learn how to perform RSA for Fracture, IM nailing, Ultrasound, Arthroplasty planning with Blueprint, etc… abstr. Books 😊