Harvard Orthopaedic Foot and Ankle Surgeon. Minimally invasive surgery. Total Ankle Replacement. Views are my own, not medical advice.
#MIS
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#TAR
🏳️🌈 Ally
@AlextheDPT
@schulte_ss
Seriously. Some women can barely walk at all after a regular delivery. Can’t image after c section.
If I did that on an ortho floor I’d have the nurses reporting me to the admin. How is this tolerated on OB units?
When do surgeons stop losing sleep the night before a tough case?
It happens less now and the bar for a “tough case” gets higher with experience.
I’ve mostly stopped worrying about being able to DO the case. But I still lose sleep over the outcome long term
#OrthoTwitter
@DGlaucomflecken
Our foot and ankle fellow was redeployed to a covid ICU acting as an intern essentially. All of his patients had podus boots. He held signs up to RNs in the room asking them to keep the feet in neutral to prevent equinus contractures. ICU docs do not see the long term problems.
20s M parkour enthusiast. Injury and pain at the right foot. Unable to walk. Xrays read as normal at local UC. Posted with permission. Took a while to block out the face. 1/x
#orthotwitter
Percutaneous reduction for calcaneal fracture decrease wound risks while restoring the shape. High risk of subtalar arthritis regardless of treatment selected even in the best of hands.
#orthotwitter
1/x
26 year old male, now 3 years out from a custom 3D printed total talus replacement for talar body extrusion. Not recovered from scene . Back at work with normal range of motion. Better than a pantalar fusion at such a young age.
#Orthopedics
#MedTwitter
#3Dprinting
40s woman with ankle arthritis in medial gutter and slight supramalleolar varus deformity. Failed scope/brostrom. Elected for double osteotomy (SMO and Lateralizing calc) with deltoid peel.
#orthotwitter
1/x
This is a surgical amputation knife. I think this will be my next bladesmithing project. Not for actual use of course. This is throwback to our surgical forefathers who could cut off a leg in mere minutes. They had to be fast without anesthesia...
#orthotwitter
#orthoblacksmith
Two weeks out. Wound healed and starting some gentle ROM. The arthritis pain is completely gone and he was off narcotics POD 2.
#totalankle
#orthotwitter
Painful peroneal tendinitis and split tears. You can see the tendon has a large nodule. This was just proximal to the subdivision of the sheaths at the peroneal tubercle. He was unable to invert his foot because the nodule would not pass into the smaller sheath.
#orthotwitter
1/
I learned this stitch from our plastic surgeon and call it the “running reverse.” I use a
#2
prolene suture and run the big throws first. Then come back with the small throws. Tie an air knot. 1/3
#orthotwitter
Anatomic and Radiographic Safe Zone for Posterior Malleolar Screw Placement - An easy intra-operative measure to use that can avoid placing hardware in the posterior syndesmosis.
@DGlaucomflecken
They are understandably focused on the acute care issues. Maybe rooms for multi speciality initiatives help out and address these less acute problems?
Ankle dislocation during soccer. Self reduced. Had to osteotomize the fibula to get in. Reduced major lateral piece and then elevated a small osteochondral fragment and rafted it with the k-wire. Now back to running and sports. Sore at end of day.
A very impressive recording of the exact moment when an elite sprinter had an acute and complete rupture of the Achilles tendon. Pay attention to the "boom".
We made the cover! And I even initialed it for everyone too. You’re welcome.
#orthotwitter
MIS foot and ankle surgery. A primer for orthopaedic surgeons.
@Ortho_BIDMC
Ankle fusion (Confirmed on CT). Patients can still have more "ankle" motion than you may expect. This patient has sag motion of about 30 deg through the TN and subtalar joints. Also explains why adjacent joint OA will happen over time due to the abnormal motion.
#orthotwitter
Working a TTC and pantalar fusions last week and wanted to share a tip on using the spider to help position the leg.
1. Hang the leg from the strap while putting in the PA screws. Easy imaging and no struggle to hold and drill.
#orthotwitter
1/2
Follow up on a prior case. 10 weeks out. Back to running and all activities including military service and intern year of residency. Not active at all ;-)
I’m happy to share that I’m starting a new position as Orthopaedic Surgeon at Brigham and Women's Hospital as of 8/5/2024!
I will continue my practice with minimally invasive and arthroscopic procedures, ankle replacement and limb reconstruction to Brigham.
@BrighamWomens
This is why surgeons always ask for the room temp to be “all the way down and low as it can go please.” Before and after a long case wearing lead. Wears my Gatorade?
#orthotwitter
When I showed this to a mentor of mine he had never thought about the loss of 1st ray varus as a sign of injury.
Hopefully this case will help others identify this finding in subtle Lisfranc injuries. 12/12
One year out and walking comfortably. Very pleased. Total ankle arthroplasty can be an excellent treatment option for the right candidate.
#orthotwitter
TTC Fusion Tip: This was an open case, but highlights a common issue I see. The calcaneus is slightly lateral and sometimes when doing the fusion you need to medialize the heel more than you can achieve. A mistake is to force the ankle into varus to accommodate. 1/x
#orthotwitter
3 for 3 of my patients today (TAR, midfoot fusion, Charcot TTC) successfully quit smoking in order to more safely have their surgery. 2 were tearful saying they had wanted to quit for years but never could.
#orthotwitter
we have significant power to improve lives beyond surgery.
“I can’t promise I can make you better, but I can promise that i can make you worse if things go wrong.” Saying “No” is a tough, but crucial part of our profession.
@OrthoFolks
#orthotwitter
#medtwitter
Hallux varus
#MIS
repair…it’s not just about
#bunions
! Now walking comfortably for first time in years and able to fit into shoes.
#orthotwitter
MIS 1st MTP fusion and DMMOs 2-4
Challenging case. 60 woman with diabetes, neuropathy and inflammatory arthritis. Atraumatic fractures and progressive deformity over course of two years. Severe pain and significant difficulty walking and with any shoe wear.
#orthotwitter
1/x
@generalorthomd
@OrthoYour
I actually was not able to imagine what a backward hip replacement even meant when I saw you’re earlier post…but that this is 100% backwards and I will never unsee that.
A short 🧵 on judging fibula length and syndesmotic reduction intraop. This was a fibula nonunion with medial instability. Many ways to do it. This is one measure that can help.
#OrthoTwitter
1/5
Let’s talk about subtalar fusions! 55 M with posterior talus fracture malunion. Now with post trauma OA and loss of talar declination. Failed appropriate nonop treatment prior to seeing me. Wants something done to help with walking.
#orthotwitter
1/x
@rkh_md
This is awesome. It gets rid of the boring fluffy center part and all the remaining pieces have some crust in it. 10/10 would recommend. What we really need is a baking pan without this part at all
Technical trick for MIS bunions:
Use a 3mm steinmann pin in the canal through the osteotomy incision. Shift the head laterally and then strap the toe to the pin with coban. Now you are hands free for the fixation step.
#orthotwitter
60 year old male with DM and RA. Neuropathy. Lacks protective sensation. Good pulses and cap refill. Worsening pain and deformity. This one took a while!
#orthotwitter
Remember this: For every person that comes to you who is mad about another doctors care there is at least one of your patients going elsewhere upset with you. 7/
“Beware the straight medial column.”
If you lose the 1st MT varus that is a sign to look for lisfranc. Draw a line parallel to the medial cuneiform and see how it intersects the metatarsal. On injured right side you see it at medial sesamoid. Lateral sesamoid on left. 6/x
This was the case in my first year of practice when I knew for sure I made the right choice. Combo calc fx, talus fx, lisfranc injury. All open. 5 years later doing well!
As a resident I would have run. As an attending I loved every minute.
What was your case
#orthotwitter
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Looking for the ATFL on MRI?
Find the slice on axial where the fibula looks like a kidney bean. Here you can see the damaged ATFL (red arrow) which appears wavy.
#OrthoTwitter
It’s my favorite tool! And thanks to
#orthotwitter
I now know that it is called a Joker! Thanks guys! Here we are doing another perc calc orif. The joker let’s you “lock pick” the posterior facet back into place
@maggiefrancis
@AlextheDPT
@schulte_ss
I think one factor is that, in general, new moms tend to be younger and healthier in average than patients getting hip and knee replacements and so their limitations/disabilities are ignored/overlooked.
“Oh you’ll be ok” ≠ actually being ok
~5 weeks out from ankle scope/deltoid repair and
@arthrex
fibula IMN for a SER 4 equivalent fracture. Healing nicely. Patient is a doctor and is starting intern year next week. WBAT since POD 1. This ankle is ready to crush the ICU!
#orthotwitter
You know you work in health care when you’re breakfast is a protein shake with two shots of espresso mixed in so you only need to carry one things with you on the ride into work.
#orthotwitter
#efficiency
Also this:
TTC fusion tip:
First wire looked good on AP, but was angled too posterior. However it was holding the alignment nicely. Leave it and bend it out of the way and put a new one in just anterior. You don’t need to re-site the original wire if it’s helping you.
#orthotwitter