Mo Imam
@MoAImam
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Professor of Digital Health| Consultant Orthopaedic Surgeon| MD PHD FRCS| Gaining knowledge is the 1st step2wisdom; Sharing knowledge is the 1st step2humanity
London, England
Joined March 2010
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Pinned Tweet
Good surgeons know when to operate
Better surgeons know how to operate
Excellent surgeons know when not to operate.
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Legendary! The picture of the 2024 Olympics?!
Jerome Brouillet captured the moment Brazil's Gabriel Medina reacted to surfing the one of the biggest waves of the day, scoring a historic 9.90, which is the highest single wave score in Olympic history 👏🌊
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"Orthopedics is the marriage of mechanics and biology." - Sir John Charnley
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@holisticgrenade
Things that saved millions of lives are (based on proper evidence)
Chemotherapy
Mammograms
Masks in public
vaccines
Antibiotics
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#منخفض_التنين The Nile is next to the pyramids for the first time in 3000 years.
#StormIsHere
#Egypt
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The 8 commandments by O’Driscoll for fixing the distal humeral fractures! Thanks
@drrogervanriet
for sharing! Published in
@JSESMedia
in 2005
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"Orthopaedic surgery is the ultimate form of problem-solving, using both science and art to help people move and live better." - Unknown
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Intramedullary Nailing vs. Plate Fixation for Midshaft Clavicular Fractures: A Meta-Analysis
The pooled odds of infection, major complications, and revision surgery were significantly higher with plate fixation than intramedullary nailing!
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Best quote for surgeons’ training is “The days are long but the years are short” by Gretchen Rubin
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This summarises general orthopaedic research! Sorry I don’t know the source of this illustration but it’s worth sharing.
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Musculoskeletal anatomy of the Shoulder and range of motion created by the Rotator Cuff muscles
#rotatorcuff
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SLAP Classification
I
Labral and biceps fraying, anchor intact (11% of cases)
II
Labral fraying with detached biceps tendon anchor (41% of cases)
III
Bucket handle tear, intact biceps tendon anchor (33% of cases)
(Biceps separates from bucket handle tear)
IV
Bucket handle tear
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Intraoperative fluoroscopic image showing two percutaneously placed Kirschner wires stabilizing a lateral condyle fracture. B,C. AP and lateral views of fracture treated with two divergent Kirschner wires.
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Posterior Shoulder Dislocation
(a) The "light bulb sign" indicates a posterior shoulder dislocation.
(b) Post-reduction imaging shows the shoulder back to its normal appearance.
(Image credit: Hellerhoff/Wikimedia)
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Lunate Dislocation
(a) Lateral View: Shows the characteristic "half-moon" appearance of the rotated lunate (arrow), which no longer articulates with the distal radius. The central axis of the capitate remains aligned with the articular surface of the distal radius.
(b) Frontal
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Never inject steroids in tennis elbow!
The evidence highlights long-term implications for the CEO.
Attenuation of the LCL can also occur after corticosteroid injections. Even one injection may result in lower complete recovery rates and in recurrence rates after 1 year.
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Some surgeons think they are perfectionists. They forget that prolonged surgery causes intraoperative hypotension, hypoxia, and coagulopathy in combination with increased blood loss and fluid
requirements during and after.
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Mass Behind Knee
DDxPosterior knee mass
Baker's Cyst
Popliteal Anerysm
Soft tissue sarcoma
Osteosarcoma / Parosteal OS
Hemangioma / AVM
Note:
Always do xray for calcification
A Bakers cyst/aneurysm can be calcified
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For some reason, AO is promoting this implant to replace 5 pounds POP or 10 pounds worth K wires! Don’t see potential advantages yet it will take more time, higher probability of infection and revision surgery won’t be easy. The learning curve will be steep too!
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"The orthopaedic surgeon is a combination of the carpenter, the mason, and the sculptor." - Paul S. Alexander
#Orthotwitter
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Here is the original 1961 publication by John Charnley published in
@TheLancet
.....a monumental piece of arthroplasty history. The Charley Hip replacement from
@wrightington16
#orthotwitter
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The reduction forceps obtain length in an oblique #. The points are placed on each main fragment up and down or cocked if the obliquity of the # line is long. The handle is rotated with the hand reversing the relative position of the clamp
jaws and lengthening the fracture
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Leadbetter Technique:
- flex the 90 deg, w/ slight adduction, and apply traction; next, internal rotation to 45 deg after fixing the femoral shaft obviously.
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Cubital tunnel syndrome: A nice diagram summarising the compression sites.
Source: .
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4 key components when positioning a hand for splinting:
1. The wrist should be positioned between 0- 10 deg of extension.
2. MCP placed at 70 deg of flexion.
3. The interphalangeal joints should be slightly flexed.
4. The thumb should be abducted, either volar or dorsally.
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Fixing the radial neck strategies. Added transverse screw in tripod construct increases stiffness in Mason III radial head fractures: a finite element analysis
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Galeazzi fracture; the fracture of necessity. It needs to be fixed in 100% of patients. Chronic disability if unstable DRUJ goes unnoticed for >10 weeks.
AIN palsy is usually overlooked because there is no sensory component
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Labral lesions. Diagram of
the normal anterior labrum from an axial perspective and the key features of Bankart, anterior labroligamentous periosteal sleeve avulsion (ALPSA), and glenolabral articular disruption (GLAD) labral lesions.
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@APresserV2
A teacher affects eternity; he [or she] can never tell where his influence stops.
― Henry B. Adams
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الواحد من زمان من ايّام المئوية كان بيفكر ان شريط المئوية بتاع
@azizelshaf3i
ده لازم يشتغل في إستاد الزمالك و ان أغنيه ملكي تبقي ذي أغنيه
#ywnwa
في
@thisisanfield
قبل ماتشات ليفربول. لما اتعمل كده في الكونفدرالية حصل تناغم واضح في كل الفيديوهات اللي شوفتها!
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Hertel Radiographic criteria
Hertel et al J Should Elbow Surg 2004
2 criteria to predict ischaemia
A. Metaphyseal head extension < 8 mm
B. Medial hinge displaced > 2mm
97% positive predictive of ischaemia if both factors present
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Bennett fracture. Intra-articular
fracture at the base of the first metacarpal
(arrow).
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Diagram of major types of periosteal reaction.
(a) Solid.
(b) Laminated (onionskin).
(c) Hair-on-end (perpendicular).
(d) Sunburst (divergent).
(e) Codman triangle.
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Ligamentous Laxity
DIAL HOME CS
Down’s Syndrome
Idiopathic (familial)
Achondroplasia
Larsen’s Syndrome
Homocystinuria
Osteogenesis imperfecta
Marfan’s Syndrome
Ehlers Danlos
Congenital contractural arachnodactyly (Marfans variant)
Sticklers
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@BBCNews
There is a trend in the management of the NHS. Let’s do the same job if not better with the same salary we paid 20 years ago ignoring an inflation of 20+% over these years. Junior doctors going to other countries and consultants reducing their hours and leaving. Health is big
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"Orthopedics is the marriage of mechanics and biology." - Sir John Charnley
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Osborne-Cotterill Lesion of the elbow; an OC fracture located in the posterolateral margin of the humeral capitellum. This lesion causes instability by affecting the LUCL over its capitellar insertion, which is associated with a residual capsular laxity,
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Our publication: Sliding hip screws versus cancellous screws for femoral neck fractures.
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The first-ever human application of the AO Fracture Monitor.💪🏥
This cutting-edge technology, developed by the AO Research Institute Davos with the AO's innovation funding.
As an important step towards regulatory approval the safety of this implantable telemetric sensor system
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Anatomical reduction of the joint and correction of metaphyseal and diaphyseal deformity greatly reduces the stress on articular cartilage
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Lisfranc injury: the first metatarsal bone remains in its
normal position with respect to the first cuneiform bone. The lateral
four metatarsal bones are laterally subluxated. The fractures of the first
cuneiform (asterisk) are not a component of the pure Lisfranc injury.
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The lag screw. a) hole next to the screw
head is larger than the diameter of the thread= gliding hole. The hole
in the opposite cortex= thread hole. As screw tightened, 2 fragments are pressed together. b 2 holes= thread holes. The fragments cannot be compressed (Müller 1979)
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Fracture-avulsion of the anterior tibial tubercle (arrow)
indicates detachment of the infrapatellar tendon.
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Radiographic positioning for axillary view. Normal axillary view showing coracoid process (Cp), acromion (Ac), glenoid (G), and glenohumeral joint (*) which is almost but not quite in profile
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Decision-making algorithm for proximal humeral fracture by Schatzker and Tile
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“Safe zone” (area of radial head that does not articulate with ulna) for placement of fixation
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Simple bone cyst. A well-defined, expansile lytic lesion in the proximal shaft of the humerus (arrows)
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We tend to forget. You realise that when you have a loved one as a patient. Then you realise you have to treat everyone as a family or a friend!
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A,B. Extension blocking splint. C,D. Alternative aluminum and foam extension blocking splint.
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@SteveBarclay
@BMA_JuniorDocs
These are the kind of jobs doctors are doing nowadays; does not make any sense in other disciplines!
Fair pay for junior doctors will achieve:
- Value and Recognition
- Retention
- Ability to pay educational Debt
- Ability to achieve professional Development
- Equity and
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The INSITE Trial: Intramedullary Nailing vs Sliding Hip Screw in Trochanteric Fracture Management is an international, multicentered RCT is the first of its kind. The results of this study suggest that sliding hip screws provide comparable clinical outcomes to intramedullary
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Chopart dislocation. Disruption of the hindfoot and midfoot, with dislocation of the talonavicular (white arrow) and calcaneocuboid
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Rayan’s technique for thumb CMC stabilization: the dorsoradial ligament is imbricated and tightened and the CMC joint is pinned with a .045 K-wire for 4 weeks
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Although latissimus dorsi transfer appears to be the more biomechanically sound option, the pectoralis major transfer has shown good results in the long term.
Although pectoralis major reproduces the position and orientation of the subscapularis in the coronal plane, its
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In 1916, Biesalski and Mayer described five main principles of tendon transplantation.
•Restoration of tendon–sheath relationship.
•Direct the tending through tissues which allow tendon gliding.
•Imitate normal insertion.
•Establish normal tension.
•Preserve an effective
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Entrapment of radial n in spiral fracture of the distal third. Nerve is least
mobile as it passes through lateral intermuscular septum in distal
1/3. The radial nerve, fixed to
proximal fragment by lateral septum, is trapped between fragments when closed reduction is attempted.
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The History of Joint Replacements in Orthopaedics!
Themistocles Gluck (1853–1942), Romanian-German surgeon who performed first joint replacement in the world in 1890, with endoprostheses made of ivory. From Wikimedia Commons.
#OrthoTwitter
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No benefit of the trochanteric stabilizing plate on loss of fracture reduction in AO/OTA 31-A2 trochanteric fractures; a randomized controlled trial using radiostereometric analysis.
There is no benefit from the addition of the trochanteric stabilizing plate in these cases. An
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Diagram of the superior, middle, and inferior glenohumeral
ligaments en face from a coronal perspective, forming the Z configuration. The coracohumeral ligament (CHL) and long head of the biceps tendon (LHBT) also are shown
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Some surgeon somewhere sent me this X-rays asking me about my opinion whether they should leave these wires for 8 or 12 weeks??? 🤦🏻♂️ thoughts?
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Scapulothoracic
dissociation: One of the proper emergencies in shoulders.
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In distal radial fractures, we need to remove clot, fibrous tissue and callus to achieve a proper reduction for fractures while preserving the soft tissue attachments to the medial aspect of the proximal fragment. as perforators from the AIN artery feed the radial shaft.
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@trishgreenhalgh
Sometimes you make the right decision, sometimes you make the decision right was my favourite quote from my late mother
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The four major fragments of the proximal humerus. 1, Humeral head superior to the
anatomical neck; 2, lesser tuberosity;
3, greater tuberosity; 4, shaft of the humerus
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Types of joints in the hand
• Carpal joints: Gliding joints
• Thumb CMCJ: Saddle
• Finger CMCJ: Gliding joints
• MCPJ: CAM shaped
• PIPJ: Condylar Hinge joint akin to knee
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Left: Note how the humeral head is centrally located over the glenoid. (Right ) Scapular Y-view showing anterior dislocation of the humeral head
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The four stages of
perilunate fractures:
stage I: trans-radial styloid
dislocation; stage II
trans-scaphoid dislocation;
stage III trans-capitate
dislocation; stage IV
trans-scaphoid trans-capitate
trans-triquetral dislocations
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Antegrade-retrograde opposing lag screws for internal fixation of simple displaced talar neck fractures
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This is so good and funny un many ways. Summarises the current social media culture of everyone having an strong opinion in everything embarrassing themselves thinking they are right! But overall it’s a funny joke.
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This study from
@MOON_Shoulder
shows that the strongest predictor of bone loss in patients with anterior instability is the number of dislocations; with each subsequent dislocation, the risk for bone loss increases significantly.
#shoulderinstability
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Lateral view shows the characteristic half-moon the appearance of the rotated lunate (arrow), which no longer articulates with
the distal radius. Note that the central axis of the capitate remains aligned with
the articular surface of the distal radius.
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Scapholunate advanced collapse wrist. The scapholunate ligament is absent, and the space between the scaphoid (S) and lunate (L) is increased. The capitate (C) is migrating proximally between the two bones (arrow). There is loss of cartilage and a decreased space
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The use of biologics as augments to rotator cuff repair attempts to promote healing by addressing many of the biological changes that occur following injury to the rotator cuff.
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