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John Shields, MD, FAAOS

Dec 23, 2022 • 7 tweets • 4 min read • Read on X

Scrolly

A thread 🧵
Very interesting case with a lot of teaching points

Elderly female with moderate hip pain - underwent right IA hip injection at OSH
#orthotwitter

2 months later presented with worsening hip pain

X-rays show AVN with collapse -

- do not inject hips in elderly females - high risk of AVN with collapse

Patient went on to get a THA at OSH. Intra-operatively could not get the cup to stick. Bail out was to cement a cementless cup. Chose blade type prosthesis - cracked the calcar, managed with cables

- if a cup will not stick there is usually a reason. Fracture? Up to size? Bone loss? Push medial?

- for these elderly females consider fit and fill stem vs cemented

Patient went on to stem subsidence and cup failure secondary to loosening - presented to our clinic with this construct and unable to bear full weight

- cement predictably failed on the bone side

Revised all - found a posterior column fracture which explains initial cup concerns. Plated column, redapt cup, femoral head allograft with montage bone graft to cover medial defect. Redapt stem. Dual mobility

Had cage available as a backup but not needed after plate

@generalorthomd

@generalorthomd @CenterRotation @DrChadKrueger @kneedoclond @BrianChalmersMD @orthogal21 @hjluks

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More from @jointdocShields

John Shields, MD, FAAOS

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Oct 6, 2023

Today I had a surgery denied. The denial letter gave me a # to call for an appeal at @WellcarePlans

I called the number - on hold way too long. Then someone answered, asked all the information, numbers, story, etc. Then told me she couldn’t help me and to call another number

I called the next number. Waited on hold. Told all numbers, story to the second person. She told me I actually had the wrong person and gave me a third number to call.

I called the third number, waited on hold, told her up front it was for an appeal - she said she could help me, then she asked for all the numbers, story, etc . She told me she couldn’t help. She transferred me to a FOURTH number.

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John Shields, MD, FAAOS

@jointdocShields

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@MediaTJC

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#medtwitter
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John Shields, MD, FAAOS

@jointdocShields

Nov 20, 2020

@JoeBiden

Since our president elect @JoeBiden #stutters I am getting a lot more questions about my stuttering in clinic. Never before has anyone been interested, so this may be progress
Let’s talk #stuttering
A Thread 🧵
(disclaimer- I am not a speech pathologist, just a simple bone MD)

What is Stuttering?

Communication disorder referring to problems in fluency and flow of speech, but can also involve physical tension as they struggle to speak.

I know what I want to say, but cannot say it.

Is is common?

It affects about 1% of the population. Males 3-4X > Females.

Affects children often when language is developing, but most grow out of it with time. Starts around age 3 1/2