@orthotraumamd @medflutter_ @OrthopodReg @generalorthomd @ojedathies @Ortho_FL Probably was malreduced in varus? Hard to tell on these X-rays. Also lag screw not central on lateral?
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ZDW
398 posts
@medflutter_ @OrthopodReg @generalorthomd @ojedathies @Ortho_FL Very odd. Would get inflammatory and infection labs. Remove all hardware. And revise to a long nail.
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History Of Short Pfn One Month Back!
Implant Failure.
What leads To this? And Further Plan?
Expert opinion needed.
@OrthopodReg @generalorthomd @ojedathies @Ortho_FL
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@real_doc_speaks @DutchRojas We need 1 organization to give $ to for lobbying on our behalf. Does said organization already exist? I give to the @orthopac but that's just fighting for money amongst different specialties
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My fellow physicians, if you are too tired to read @DutchRojas posts, let me summarize it:
Doctors: Organize or die!
Dutch Rojas@DutchRojas
Some days I wake up and I’m like… do physicians actually enjoy getting their asses handed to them by a handful of mid-level bureaucrats at the AHA and FAH? I mean, have you read these bios? Seriously. You go through them and you’re waiting for the big moment—“Ohhh this is where the genius comes in”—and it never shows up. It’s just… some guy. Another guy. And somehow these guys have spent the last 20 years absolutely steamrolling an entire profession. Physician ownership? Gone. Reimbursement? Down for two decades. And the beatings? Oh, those are still very much on schedule. Then you talk to physicians about it. And what do you get? A thread. A post. A strongly worded LinkedIn essay. “Oh, this is outrageous.” Yeah? Then do something. You say, “Hey, why don’t we fight back? We hire like 10 legit lobbyists, get organized, push policy...” And immediately it’s: “Ahhh, I don’t know, reimbursement’s down…” “My kids are in college…” “Timing’s not great…” The timing is not great? When is it gonna be great? When they take the last dollar out of your pocket and invoice you for the privilege? It’s unbelievable. You’ve got one side playing full-contact politics, and the other side’s writing Yelp reviews about it. At some point, you gotta stop complaining and realize you’re not losing because they’re brilliant. You’re losing because they’re actually playing the game… and you’re sitting in the stands explaining why you can’t. In the meantime, another pharma company donated $50 billion over the next 10 years, and pro fees are down again, while facility fees are....UP UP and UP!
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@solimanibra92 @InvictaOrtho @FootAndAnkleMD @Gnomelover1970 @traumaticum @IMNailR @FractureDoc Looks like both screws are bicortical but the distal one wasn't tightened down fully. I wouldn't change anything
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Hello #orthotwiter
I made an unintentional mistake
I didn’t notice that the second proximal screw didn’t fully engage the far cortex
Should I delay WB ? What’s the best approach in this case?
@InvictaOrtho @FootAndAnkleMD @Gnomelover1970 @traumaticum @IMNailR @FractureDoc
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@DrDiGiorgio @sonodoc99 @HouseCommerce Appreciate your efforts to help independent physicians (the few of us remaining)
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It was an honor to testify in front of the @HouseCommerce subcommittee on health regarding healthcare affordability.
We discussed consolidation and the demise of independent physician practice.
My solutions include:
Repeal section 6001 of the ACA which banned physician owned hospitals
Reform Stark law
Implement site neutral payments
Reform 340B
Use FMAP to encourage states to be pro-competition (repeal CON, eliminate non competes)
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@DrDiGiorgio @GmOrr9000 @HouseCommerce I hope someone will fight for the few remaining independent physicians. CON laws, physician owned hospitals, decreasing medicare physician reimbursements year after year
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I’m honored to testify before the @HouseCommerce Health Subcommittee on March 18 as Congress examines the background, scale, and consequences of rising health care costs.
Health care affordability is one of the defining policy failures of our time.
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@alexmd2 @CE_HandSurg Sure. But I'm pretty sure my local hospitals have no issues with financial stability. They're gobbling up physician practices left and right
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@zweidner @CE_HandSurg If you are using OR you want the hospital to have financial stability to have OR staff and necessary supplies or DOH would close it down and you have no place to operate - happened about 10 years ago at our local hospital.
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The discharge summary is the most antiquated useless documentation of a clinical documentation.
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@alexmd2 @CE_HandSurg Frankly, the few remaining independent doctors left in this country don't really care about the hospital payment since we have nothing to gain by it
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@CE_HandSurg If you dont care if you get paid, because this is how hospitals get paid.
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@CE_HandSurg @CoffeeBlackMD No, all Ortho bros agree. Who has even ever read a discharge summary after the fact?
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@CoffeeBlackMD The requirement is heavy handed and a waste of time time for routine over night stays after scheduled surgery. But apparently all the nerds love them and I'm in the minority here.
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When I say u can get a $2k/night Ritz Carlton for $250 no one on this app believes me
iykyk
Phantom Rates are the truth
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@DrJesseMorse Dude, you aren't an orthopaedic surgeon so stop commenting like you are. If you were you would know the proximal fibula fracture doesn't need fixed here
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Sorry, I failed to comment/missed the proximal fibula fracture that they did not surgically address.
Either this is something they’re going to address at a later date or they decided to allow it to heal on its own.
Additionally, there is a very important nerve that wraps around the head of that fibula called the peroneal nerve that sometimes gets injured with this type of fracture.
This often leads to foot drop.
It remains to be seen if she has any nerve damage and how they will address this proximal fibula fracture.
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Lindsey Vonn shares her actual X-rays post 6+ surgeries!!!
Looks like a severe proximal tibia fracture.
Tibial plateau fracture + Metaphyseal/Tibial Shaft fracture
Appears that fibula is intact.
Unclear if the femur was involved.
Based on initial photos, I wouldn’t be surprised if there was an open wound and possible fasciotomy due to compartment syndrome.
LONG rehab journey ahead but nothing she hasn’t done probably 5 times already.
Mind you eventually she will (likely) have to have her ACL reconstructed.
Good luck girl!
lindsey vonn@lindseyvonn
I’m bionic for real now 🦾
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A Greek family living in Miami sent me the following images. The child was first evaluated in the Emergency Department and subsequently by a private pediatric orthopedic surgeon.
The second set of radiographs reflects the current status, at 2 weeks post-injury.
@Davembmd
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I guess I will not longer feel guilty when one anchor go to waste when doing hip labral repair
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Most surgeons had shifted from use of K-wires in tension band fixation of patella fx to use of cannulated screws. However, common mistake I frequently find is screws are beyond the edge of patella, making any trial compression by the wire acting on the tip of the screw not bone.
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@NeilFlochMD @Third_i_Prophet 0? That's crazy. Ortho still independent in VA but dwindling
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@Third_i_Prophet My private practice was eliminated. There are NO general surgery private practices in Connecticut.
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The one point that the general public must understand is that the cost of medicine, the rise of hospitals systems, and the fall of private practice has occurred largely because government has allowed hospital systems to be paid a “facility fee” that independent physicians cannot collect. pgpf.org/article/what-i…
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@pjamiesonkay @txsportsdoc Yeah, I'm interested in what the hospital's cut is
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@txsportsdoc I wonder what the hospital gets paid for allowing this space to be used in this way- that might be an interesting number
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So local HCA hospitals are requiring reps to pay $9 for paper scrubs when thy come to hospital. For reps who go to several hosp/day this is a significant expense to them. There is also zero evidence that wearing paper scrubs or making people change scrubs lowers SSIs. Can’t stand “policies” with no evidence. Can be sure some charge nurses are empowered and made to enforce this policy. I don’t miss going to these large systems.
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HUGE UPDATE: Thanks to @CMSGov, at least 8 states have made commitments to roll back their Certificate of Need laws as a condition of extra funding from the Rural Health Transformation Fund.
AK, DE, IA, MD, NE, RI, SC, and TN (image below) have committed.
cms.gov/files/document…
Lawson Mansell@lawsonhmansell
This is a good time to mention that the OBBBA's rural hospital fund will determine funding to states in part based on whether or not they repealed their CON laws.
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Not my case, does anyone have links to literature on length of nail and number of distal locking screws needed for antegrade femoral shaft nailing? I can share follow up X-rays if interested tho not really the point
@traumaticum @rkh_md @generalorthomd @centerofhip @InvictaOrtho
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