[1/18] Kicking off the new year with some tips of how I do a short cephalomedullary nail for an intertrochanteric fracture. The cases I use here are not all the same and aren’t always “perfectly done” but I try to showcase the best example of the technique itself. [2/18] If you don’t have table with overlapping legs like Hana (sigh), and have a limit to adduction (red), and don’t want to tape nonop leg to the bar or do lithotomy (I hate that position as can cause compartment syndrome), there are a few things you can do with fracture table.

[1/8] Tongue type calcaneus fracture treated with percutaneous Essex Lopresti maneuver. So how did I get from this to this using only 2 pins? The paper by my mentor is here but I’ll go through some of his slides to show you the technique as well. pubmed.ncbi.nlm.nih.gov/9781770/ [2/8] Lateral decubitus is what you want so you can convert, but this can also be done prone (although harder). Unlike most people, he does not use Harris, only AP and lateral and the paper talks about that.

[1/12] Complex closed plateau with comminuted metaphysis/shaft component. Brace yourselves— lots of steps to get this right if plating. Right off the bat you need to decide, will you bridge or direct fixation? Ring fixator? My path was direct plating BUT other options fine too. [2/12] 3D CT of medial, posterior, and lateral. Let this percolate in your brain a minute— what is the order of fixation? How many approaches? Which fragments have joint on them and must be fixed?

[1/9] Lots to learn from a simple ankle Xray. At first glance this looks like a “standard” bimal, and yet the medial malleolus isn’t the usual fracture pattern. It almost seems “intact” (yellow). There is crack proximally (red), and joint widening with talar subluxation (green). [2/9] The lateral shows us the fibula fracture which is the standard SER pattern (proximal posterior to distal anterior), as well as the talus subluxating posteriorly with the posterior malleolus fragment, making the joint incongruent.

[1/9] Good evening, pull up a chair and turn on the sound... I would like to chat about the largely ignored and vastly undertreated societal plague of OSTEOPOROSIS. Twitter only allows 2 min/video so this is in 9 bite-size parts. Meant for lay people and medical people. Enjoy! [2/9] osteoporosis definitions

[1/11] Nonunion teaching case. These are my most challenging/frustrating but rewarding cases. Injured 5 months ago—not quite 9 month FDA definition but fit Brinker (“unlikely to heal without intervention in surgeon’s opinion”). Leg floppy, varus and externally rotated 90 degrees. [2/11] Although this seemed like clear case of undertreated hypertrophic nonunion with stability issue, CRP slightly elevated so I did 2-stage. First was bone biopsy and cultures, which were negative. It also showed how big metaphyseal gap is once hypertrophic bone cleared out.

[1/17] A story. The talk about death yesterday reminded me of my patient from years ago. Mary (not her real name) was 95, in great health, active in the community and all mental faculties at full strength. She fell and had a hip fracture for which I had to do a hemiarthroplasty. [2/17] Depending on the study, hip fracture mortality rates are 20-40% at 1 year, usually from heart issues. That’s why we call it a “sentinel event,” and the death generally has nothing to do with the surgery; hip fracture is an indicator of frailty. But I thought, not Mary.

[1/6] When I interviewed for BA/MD program at age 17, I sat in the lobby with a bunch of genius kids who were all talking about their biochem research. I was a kid who wrote stories; fanfiction to be exact. I figured there was no way I’d be getting in, so might as well have fun. [2/6] The interviewer surprised me by asking about my stories. In previous Ivy schools etc, it was obvious they just saw my application that day, but it was clear this guy had actually read it. I wasn’t sure why he was asking; I had expected to talk about grades and science.