Welcome to Season 2 of the Orthobullets Podcast

Today's Foundations episode will focus on the topic of the Femoral Shaft Fractures.

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#orthosky #medsky

Welcome to Season 2 of the Orthobullets Podcast

Today's Podiums episode will focus on the talk given by Dr. Howard Routman, and is titled "All This RSA Talk.... Can You Break it Down Into the Basics."

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Can you answer this daily question from our Free QBank correctly?

QID: 218180
Comment your answer below, then check to see if you got it correct by clicking the link below to see the answer & explanation.
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The decision was made to proceed with an open Latarjet procedure. (see the intraop video on the site)

7 months (Dec 2023) after his Open Latarjet, while moving objects during a move back to California, he had a recurrent shoulder dislocation. Here are the x-rays after his recent dislocation.

6 months (May 2023) after his Bankart + Remplissage procedure, he had a recurrent shoulder dislocation while playing basketball. Here are the MRI images following his recurrent dislocation.

Here is an intraoperative image from his Bankart + Remplissage procedure. (see the full video in the link above)

Here are the initial presenting MRIs images from Sept 2022, prior to his Bankart procedure.

RECURRENT DISLOCATION S/P LATARJET - DEC 2023

Seven months after his Open Latarjet, while moving objects during a move back to California, he had a recurrent shoulder dislocation.

PMH: No significant past medical history.

PE: Current physical exam is positive for apprehension.

RECURRENT DISLOCATION S/P BANKART- MAY 2023

6mo after, he had a recurrent shoulder dislocation while playing basketball. 2 more dislocations occurred over the following 2 weeks. Following radiographic evaluation & conversations, a decision was made to proceed w/ an open Latarjet on 6/1/2023.

Initial Presentation (cont.):

He had an ISS Score of 4 (maybe 6 if we give him HSL based on MRI). Initial imaging showed 18% bone loss (Subcritical), Track Measure (GT) =17.2, and HSL =16. The decision was made to do a Knotless Bankart, Remplissage on 11/15/2022.

HPI: INITIAL PRESENTATION - SEP 2022

A 20 y/o male Basketball player presented with three dislocations of the left shoulder. He reported it would “come out in my sleep.” On exam, he had positive apprehension, a negative push/pull posterior, a sulcus visible but asymptomatic, & Beighton score 5.

Here is a new case by Dr. John Tokish and Mayo Clinic.

RECURRENT SHOULDER DISLOCATION S/P LATARJET IN 20M

This case will be debated at Antarctica 2026: Breaking the Ice Conference in Antarctica, Jan 14-24.

How would you manage this? #orthosky #medsky

Vote for CME: orthobullets.tiny.us/2m9nrrts

Welcome to Season 2 of the Orthobullets Podcast

Today's Podiums episode will focus on the talk given by Dr. Arun Mullaji, and is titled "The When, Why, and How I Adopted the Anterior Approach."

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Can you answer this daily question from our Free QBank correctly?

QID: 219179
Comment your answer below, then check to see if you got it correct by clicking the link below to see the answer & explanation.
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If you choose PSIF + TLIF, what type of interbody implant would you utilize?
- 1 Straight/Bullet Cage
- 2 Straight/Bullet Cage
- 1 Banana-shaped Cage
- 1 Expandable Cage

Here are postop images of yesterday's case by Dr. Ali Baaj and Sananthan Sivakanthan from Banner Health.

LEG AND BUTTOCK PAIN IN 65M

PROCEDURE: L4/5 MIS TLIF

Do you agree with the treatment? Why or why not? #orthosky #medsky

Vote on this case for CME: orthobullets.tiny.us/2p92uayd

Here is a preoperative x-ray showing pelvic measurements.

PE: On exam, he is non-focal. He has full strength in BUE in Deltoids, Biceps, Triceps, Wrist Extension, and Handgrip. He has full strength in BLE in hip flexion, knee extension, plantar flexion, dorsiflexion, and EHL. He has no Hoffman, clonus, or Babinski, and his DTRs are 2+.

PMH: No significant past medical history. Past surgical history is significant for remote history of ACDF.

HPI (cont.): His pain has significantly limited his quality of life, and he is now unable to enjoy activities he previously did. He has failed conservative treatment w/ physical therapy, injections, and ablations.

HPI: A 65 y/o male presents as an outpatient w/ a few yrs of progressively worsening RLE radicular pain, numbness, & paresthesias in an L4 distribution. He endorsed evidence of neurogenic claudication w/ pain that worsens on extension, is relieved w/ flexion, and worsens w/ activity.

Here is a new case by Dr. Ali Baaj and Sananthan Sivakanthan from Banner Health.

LEG AND BUTTOCK PAIN IN 65M

How would you manage this? #orthosky #medsky

Vote on this case for CME: orthobullets.tiny.us/2p92uayd

Here is an intraoperative image.

Here are additional postoperative images.

Here are intraop & postop images of yesterday's case by Dr. Christopher Johnson & Orthopaedics NorthEast.

SHORT SEGMENT OF REMAINING BONE IN 32F

PROCEDURE: COMPLIANT PRE-STRESS IMPLANT (COMPRESS)

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Here is an axial CT scan of the femur to assess cortical thickness.

PE: On physical examination, the patient demonstrates an antalgic gait due to a significant leg length discrepancy. Quad strength is 5/5 bilaterally. The surgical site shows an extensile medial approach, with no signs of infection or wound dehiscence noted.

PMH: History of distal femur osteosarcoma, diagnosed 14 yrs ago & treated at an outside hospital. Underwent neoadjuvant chemotherapy, followed by wide excision of the tumor & adjuvant chemotherapy. She underwent reconstruction w/ a distal femur replacement utilizing a Compress w/ a medial approach.

HPI (cont.): Knee aspiration showed no evidence of periprosthetic joint infection w/ a synovial white blood cell count of 900, PMN percentage of 14%, and negative alpha defensin test. The patient is currently 10 weeks pregnant.

HPI: 32 y/o female presents w/ progressive left hip pain. She is unable to ambulate due to severity of pain. Lab workup, including serum CRP and ESR, has returned normal.