kostas D

Trauma & Knee Surgeon | Fellowships: Trauma, Lower Limb Sarcoma, Knee (Soft Tissue & Arthroplasty)

[kostas D @kostasd87]

@northwoods1980 L clavicle osteoid osteoma would be my first guess. I think I can discern a nodus within the inferior cortex. However this is only a guess without an MRI

[Dr Singularity @Dr_Singularity]

Abundance is coming. Actual, ridiculous, post scarcity abundance. The bottleneck was always (not enough) intelligence. That bottleneck just broke.

[kostas D @kostasd87]

@David32791605 @UKDecline A reading of -34% means that 34% more surveyors reported falling prices than those who reported rising prices.

[kostas D @kostasd87]

Long nail.
Looks pathological - if the patient has cancer history I would CT first as it could change management (long life expectancy & pathological fx may be better managed with PF EPR).
Assess for stiffness/OA/fixed flexion in the contralateral hip before setting up for a nail. If FFD then set up the fx table with some hip flexion. It's impossible to get the fx fragments to meet if the proximal fragment is fixed flexed and the distal extended.

[kostas D @kostasd87]

@sportsdoc2016 @traumaticum @InvictaOrtho @orthotraumamd Excellent. Glad to hear the Bob Handley screws worked!

[kostas D @kostasd87]

@medflutter_ @DrFraneNicholas @IMNailR @orthotraumamd Personally, I’d have preferred 3 proximal screws for a fracture above the isthmus, but I don’t think you did anything wrong. T&O is humbling like that. Sometimes you miss a detail and the patient does well, sometimes you do everything right and they suffer.

[kostas D @kostasd87]

@northwoods1980 Borderline criminal, unless instability present, which I highly doubt

[Mo Imam @MoAImam]

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[kostas D @kostasd87]

@InvictaOrtho Looks like we are winning. Lag screws have loosened as expected but metalwork intact & patient walking without aids. Still watching this one

[kostas D @kostasd87]

Difficult medial malleolar fractures: salvage options
72 year old f&w lady pulled by the dog sustaining this fracture. Closed but with moderate skin tethering medially just above the medial malleolar fragments. Rudimentarily reduced in ED and operated next morning.
#orthotwitter

[kostas D @kostasd87]

@InvictaOrtho Current state of medial malleolar area

[kostas D @kostasd87]

Thank you for this post. Have long thought elbow braces are not fit for purpose. Backslab for 1-2 weeks post injury and bulky bandaging for the first days postop is what I rely on. And then early active ROM exercises supine with arm vertical and forearm above torso, effectively using the forearm weight to maintain ghe elbow in joint

[kostas D @kostasd87]

@InvictaOrtho Thank you Yelena, a very good point. Unfortunately It didn't cross my mind at all at the time...

[kostas D @kostasd87]

@InvictaOrtho Hopefully in the process of. XRs up there were not much different. He still has some pain. We'll have new XRs in 2 months 🤞🏻

[kostas D @kostasd87]

Distal locking failure
75yo comorbid gentleman, broke the distal locking screws of his Gamma2. Initially had a length unstable butterfly subtrochanteric fixed 5 months ago. Bloods negative, no signs of infection. New onset mild knee symptoms.
#orthotwitter

[kostas D @kostasd87]

@centerofhip Good job, loved the article. I wanted to try it since I read it in 2021, still haven't found an appropriate case

[kostas D @kostasd87]

Intraop cultures came back negative 🙏🏻. The patient is recovering, 8 weeks down the line still has some pain but can now WB.
Would you have done something different?

[kostas D @kostasd87]

We ended up doing this. Removed the lateral half of the screws and pushed the rest out using the screwdriver & II. Then inserted the bolts. Wanted to protect the knee so I inserted another advanced locker distally. The idea was they the first resistance would be the regular bolt, then the nail would migrate proximally to be held by the advanced locker at the end of the oblique hole and the distalmost screw.