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Dr. Edward Oates Profile picture
@traumaticum
Mar 19, 2023 • 7 tweets • 3 min read • Read on X
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Let me take you on a journey... #orthotwitter
"no, the triceps tendon was not augmented, why do you ask?"
no problem, we'll revise it, this time with augmentation.
yeah, no.
I got to revise it after the 2nd failure. went with 2 stage just to make sure (took the short 72hr microbiology option). took everything out, Joint absolutley stable through full PROM. ABx spacer.
Given joint stability, aim was to readapt tricpes for extensor function. revised at 5 days, no indication of infection. 4 Strand fibertape locking stitch into triceps (mobilised and distalised a bit) then ran fibertape through the fracture and intramedullary down the ulnashaft,… twitter.com/i/web/status/1…
moral of the story - suture augment the triceps tendon during the index surgery!

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More from @traumaticum

Dr. Edward Oates Profile picture
Feb 4
The 2nd edition of my biomechanics course is in the works, and whilst Im fine tuning some improvements, here's some background to what I've developed:

The FRACTAL algorithm provides a framework to systematically approach fracture evaluation and treatment using principles rooted in mechanical engineering and physics. It emphasizes an iterative process where each step builds upon the previous one to develop a robust solution tailored to each biomechanical challenge. ⬇️

#orthotwitter #orthoX #orthopedics #orthopaedicsImage
Frame
The initial step involves establishing a simplified representation of the complex biomechanical system. This includes isolating the area of interest, and defining an appropriate frame of reference. The surgeon creates a conceptual model that delineates the boundaries of the problem, akin to setting up the initial conditions for a free body diagram. This step is needed for reducing extraneous variables and focusing on the pertinent mechanical interactions within the system.
Resolve
In this phase, force vectors acting on the system are resolved into their fundamental components. This simplification allows for an analysis of how individual forces influence the biomechanics of the fracture. By breaking down complex force interactions into manageable orthogonal components, typically along defined axes (e.g., X, Y, Z), we can better understand the primary vectors contributing to stress, strain, and potential deformation at the fracture site.
Read 9 tweets
Dr. Edward Oates Profile picture
Sep 1, 2023
What could be easier than removing a screw? Bad technique puts you head-to-head with screw mechanics, and in the case pictured below - F_static - aka static friction or stiction… 🧵👇

#orthotwitter #orthopedics #orthopaedics Image
Static friction is the resistance to the initiation of motion between two surfaces at rest, requiring an initial force to overcome it. Kinetic friction, on the other hand, opposes the relative motion between two surfaces that are already in motion and is lower than static friction once motion has begun.
When removing a screw, if you turn a 1/4 or 1/2 a turn at a time and pause, you never enter into the kinetic friction zone. Every time you apply a torque to turn the screw, you need to overcome static friction - again and again
Read 7 tweets
Dr. Edward Oates Profile picture
Aug 6, 2023
It sounds like an easy question: "How does a screw work", but the simple screw is often mechanically abused in orthopaedics - thus i thought it worthwhile recapping what forces screws generate, and how they function in fragment fixation. #orthotwitter #orthopedics #orthopaedics Image
In mechanical engineering terms, a screw is an inclined plane wrapped around a cylindrical shaft, converting rotational motion to linear motion. As it advances, the thread's inclined plane generates an axial force, while a combination of wedging and friction secures the screw… twitter.com/i/web/status/1…
When a screw is tightened, it utilizes mechanical advantage to convert rotational motion into linear motion. The inclined plane of the screw's thread pushes into the material as the screw advances. As the head of the screw engages, the axial force generated by the threads creates… https://t.co/KobF3RphKPtwitter.com/i/web/status/1…
Image
Read 10 tweets
Dr. Edward Oates Profile picture
Jul 31, 2023
So what exactly does Koch mean by "the medial cortex of the femur is in compression, the lateral side in tension"? and is it actually true? #orthotwitter #orthopedics #orthopaedics Image
Koch’s principle is stolen directly from mechanical engineering. A beam placed in bending, due to the principle of equilibrium and the distribution of forces along the beam’s cross section, experiences compression on one side, whilst the other side experiences tension Image
The bending force experienced by the femur, is a consequence of the difference between mechanical and anatomic axis. Whereby we're not interested in the angle (6deg), rather the perpendicular offset of the load vector from the axis of the beam, creating a bending moment Image
Read 4 tweets
Dr. Edward Oates Profile picture
Mar 20, 2023
Some days i regret getting out of bed
#orthotwitter
I'll post these, even though theyre far from pretty. lots of reasons why this or that shouldve couldve wouldve. not something i enjoyed much. Cables doing their best where there was no tube to reconstruct. 85yo bone was dust. screw went into the best bit of the head. open to… twitter.com/i/web/status/1…
both vastus lat and glut med on the trochanter fragment. made getting past the lateral wall of tissue a huge PITA without defunctioning something big. managed tho. dozens of intermediate fragnment. only read was lateral distal trochanter to diaphysis. only had 10mm of overlap.
Read 5 tweets
Dr. Edward Oates Profile picture
Nov 20, 2022
Cerclage wires got a good wrap in 2022. Several conference presentations, a couple of posters and abstracts, and now here's a mini literature collection for @DrMarecek and myself to bath in the next time the topic comes up #orthotwitter

osteosynthesis.org/42003807-commi…
pubmed.ncbi.nlm.nih.gov/35618854/
pubmed.ncbi.nlm.nih.gov/34510127/
pubmed.ncbi.nlm.nih.gov/34825927/
pubmed.ncbi.nlm.nih.gov/34435729/
pubmed.ncbi.nlm.nih.gov/32918572/
pubmed.ncbi.nlm.nih.gov/35377073/
just an aside, i was honestly a bit skeptical whether people would follow links to off-site content, and looking at the 30 odd likes on this tweet i was thinking "well there you go, not much interest/engagement". huh.. was i wrong, i just looked at site stats ~600 click-throughs!
Read 4 tweets

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