If you’re new here, I like to talk about hardware and implants on Fridays. Previous editions have included interesting reduction clamps, OR tables, screw biomechanics, THA revision acetabular constructs, and more. What I learned today Today I wanted to cover elbow arthroscopy. But it’s a pretty broad topic. The catalog for Arthrex’s sh-elbow arthroscopy stuff is literally 100 pages long. So let’s focus on categories of arthroscopy equipment. By the way, here are some great intro articles for elbow arthroscopy by one of my mentors. Be sure to check out the actual videos linked in Supplementary ..read more

I’ve mentioned my wrist pain in a previous email on wrist clunk. Triggers: typing and using a keyboard (laptop or desktop). Relieved by: partying and chilling and enjoying life, my friend. What I learned today I usually have elbow pain that accompanies my wrist pain (yay me). Cubital tunnel syndrome is on the differential. So, might as well learn about diagnosing it, right? Symptoms Altered sensation of the little and ring fingers, worsened by prolonged elbow flexion May report hand weakness, loss of fine coordination (e.g. difficulty clipping fingernails) Occasionally, pain along the ul ..read more

Hope you enjoyed your break and thanks for sticking around. Or hi ? if you’re new here. What I learned today Fractures of the femoral head are significantly less common than those involving the neck. That doesn’t mean they aren’t worth understanding and learning about. Multiple classification systems exist but we/Orthobullets use the Pipkin classification. It's fairly straightforward: Type I: fracture line inferior to the fovea capitis (no involvement of weight-bearing surface) Type II: fracture line superior to the fovea capitis Type III: type I or II + femoral neck fx Type IV: type I ..read more

Continuing from yesterday’s email about the effect of spinopelvic alignment on THA, today we’re going to discuss spinopelvic parameters (pelvic incidence, sacral slope, etc etc). To be perfectly honest, this is a topic I’ve read or heard about several times. But it’s always so hard to remember. Maybe writing about it will help. What I learned today First, a question to test your understanding: If a patient has a hip flexion contracture, what is the likely compensatory change in pelvic tilt when standing? Answer: Anterior pelvic tilt will help align the limb perpendicular to the ground in the s ..read more

ANNOUNCEMENT I will be gone during Memorial Day weekend. No newsletters on Friday-Tuesday. Lately, I've been writing a lot about Hand and Trauma because we are currently covering those topics in didactics. Also, they are my next two rotations. But in the spirit of fairness, I will try to do something else today. What I learned today There are two parts to this topic. Today, I’ll discuss how altered spinopelvic alignment affects total hip arthroplasty. Tomorrow, a more thorough review of spinopelvic parameters. Spinopelvic alignment and THA In this great primer video from Dr. Jerabek (HSS)1, he ..read more

I’m not gonna lie… I read more of the hand and wrist exposures article, and I feel like I have nothing to contribute that would be better than Hoppenfeld’s. So instead, I’ve compiled a list of *some* of the ortho podcasts out there. One of my gripes is that when you search “ortho” or “orthopedic surgery” in Spotify/Podcasts/whatever, not all of them show up in the search results. It requires some digging and word-of-mouth to find them. What I learned today That being said, I haven’t listened to all of these. I would like to come back and write detailed reviews of my favorites at some point in ..read more

Originally I wanted to talk about hand and wrist approaches, which is the title of this JAAOS review article. However, the first section called “Innervation” brings up some good teaching points about advanced hand and wrist anatomy. What I learned today First, a reminder of the sensory innervation of the hand: (Image linked to Orthobullets, original source unknown) Superficial branch of the radial nerve (SBRN) - Innervates the dorsoradial hand, dorsum of thumb and index fingers, radial aspect of long finger - Divides into a few branches that are joined by the terminal branches of the lateral ..read more

We moved my research rabbits to a secret secure research facility in the middle of nowhere. Then one of them died suddenly today while I was checking on her. After secondary euthanasia methods, I had to drive her dead body back to our main lab. Poor bunny. Sad sad sad. When we have to sac all of them, I will be Very Sad. What I learned today On Friday, I talked about pelvic ex-fix techniques. One downside of using these for definitive management is that the patient has to walk around with some metal sticking out of their pelvis. Pin tract infection, pin loosening, and patient dissatisfaction m ..read more

Implant Friday ? Let’s hit it. What I learned today Most commonly, pins are inserted into the AIIS directed toward the posterior ilium. This image is part of a technique guide and the clamps will be tightened after reduction is complete. AO Surgery Reference Another option is pinning the iliac crest about 15 mm posterior to the ASIS. This avoids the lateral femoral cutaneous nerve and utilizes the thickest section of bone — the gluteus medius pillar. Haven’t seen this one in person yet during my limited Trauma months. DePuy Synthes Also, the AO surgery reference has this helpful guide for the ..read more

I went through a phase where I was really interested in indocyanine green (ICG) angiography. Doesn't everybody? What I learned today This paper in CORR actually won the Chitranjan Ranawat award at the 2015 Knee Society meeting. The fundamental question is, what is the best skin closure method for TKA? The study design was a prospective RCT. The authors randomized patients to 3 commonly used methods: running subcuticular, vertical mattress, and skin staples (n=15 per group). Exclusion criteria included previous knee surgery, smoking within one year, diabetes, PAD, long-term steroids, long-term ..read more