William Durchholz

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[William Durchholz @willdurchholz]

I’m going to be an orthopaedic surgeon! #Match2024 #OrthoTwitter

[Christian Pean MD,MS @DrChristianPean]

$523.

That's what the physician work of a total knee replacement pays under Medicare's proposed 2027 fee schedule. The surgery, the risk, and every visit for 90 days after.

A total hip: $505.

[Howard Luks MD @hjluks]

I’ve been an orthopedic surgeon for nearly 30 years, and a few patterns have become impossible to ignore. One is that many musculoskeletal problems in adults aren’t sudden injuries. They’re the moment when declining capacity and awful metabolic health finally reveals itself.

Over the decades your strength fades, muscle mass declines, as your aerobic capacity tanks. Tendons and connective tissues lose substance, stiffness, and resilience. For years the body compensated... quietly. Then one day a knee hurts during a run to get the train, or shoulder aches reaching overhead, or a back tightens lifting something simple.

At that point the story usually becomes more about structural damage. An MRI gets ordered. Welcome to high-tech, low-medicine. And the MRI almost always finds something. A meniscus tear. A rotator cuff tear. A disc bulge. Why? Because by midlife these findings are extremely common — even in people with no pain at all. If you have a tear in one shoulder, image the other shoulder... you probably have the same tear there. But I digress.

Once the scan appears, the narrative changes. The image becomes the diagnosis. Now the patient believes something is broken, and the focus often shifts to fixing what the MRI shows.

What often gets lost in this is the reason the symptoms appeared in the first place. Many so-called “atraumatic” orthopedic complaints are not purely mechanical failures. They are the moment when reduced strength, declining tissue capacity, and sometimes broader metabolic health issues finally reach a tipping point. Our tissues change over the decades... get over it.

In other words, the MRI didn’t create the problem. Well... it sort of did in this scenario. But all the MRI showed was something that was already there.... because of your age, lifestyle, health and so on.

The real driver of symptoms is often loss of physiologic reserve. Less muscle. Less tendon or aerobic resilience. Less tolerance for load, etc.

Once the MRI enters the picture, the risk becomes overtreatment. This is probably the number one reason people have surgery. When in many cases the most powerful intervention was never the scan or the procedure.

It was rebuilding capacity.

Strong muscles stabilize joints. Aerobic fitness improves metabolic health and tissue perfusion. Gradual loading restores tolerance.

But people often don't take PT seriously prior to surgery. They often take PT very seriously afterwards. Therefore, PT is probably the reason you feel better, despite the surgery.

The irony is that the treatment many people ultimately need is the same thing that might have prevented the problem in the first place.

Staying strong. Staying active. Maintaining the reserve that protects our joints/tendons/muscles/abilities as we age.

[NFL @NFL]

Colts will start QB Philip Rivers on Sunday at Seahawks. (via @rapsheet, @mikegarafolo, @tompelissero)

[Mark @TheAuburner]

If you don’t count the blowout loss at the start of the season and the blowout loss at the end of the season, Alabama’s resume does look pretty good, if you don’t count the loss in the middle of the season.

[Brady Quinn @Brady_Quinn]

So folks at @espn are upset ND isn’t playing in a bowl game after weeks of folks politicking against the lack of conference affiliation, using them as a pawn for their CFB playoff selection show, having the ACC network play the UM/ND game on repeat for 48 hours during Conf Champ week BUT now it’s a bad look they don’t want to serve ESPN’s best interest by playing in an exhibition bowl game? Got it.

[Robert Griffin III @RGIII]

The CFP selection process is a joke.
Punish BYU for losing the conference championship game, but don’t punish Alabama and you leave out Notre Dame. The bias has never been more clear.

[Dan Orlovsky @danorlovsky7]

Notre Dame should have been in over Alabama

[Exposing SEC Bias @overrated_sec]

Ohio St lost and fell.

BYU lost and fell.

Virginia lost and fell.

What happened when Alabama got dominated while racking up -3 rushing yards?

[Neil Stone @DrNeilStone]

This study was SUPPRESSED

They DON'T WANT YOU TO KNOW THE TRUTH

[CFB Home @CFBHome]

Stadium of the Night 🌚

🏟️ Key Stadium
✔️ Capacity 5,500
📍 Indianapolis, Indiana

Home of @UIndyFB

[Shams Charania @ShamsCharania]

BREAKING: Free agent center Myles Turner has agreed to a four-year, $107 million deal with the Milwaukee Bucks, plus a player option for year four in 2028-29 and a full 15% trade kicker, sources tell ESPN. Stunner.

[BrickCenter @BrickCenter_]

OKC just grabs player’s arms on D and the refs just watch 😭😭

[William Durchholz @willdurchholz]

@orthobullets @IMNailR @DrAJ26001405 @schulte_ss @bonesmith_ @DrFraneNicholas @eric_novack @stevemchale @FractureDoc @jamesablairMD @itius @rkh_md Damage control orthopaedics - going to E&D open wounds and ex fix until patient is resuscitated prior to definitive fixation of long bones -> both bone forearm fx. Interesting case highlighting management of polytrauma!

[William Durchholz @willdurchholz]

@olsonplanner Was hoping to get on SAVE LAST year when I graduated medical school in 2024. Here we are coming up on almost 1 year and I haven’t been able to make a payment, meaning I’ve lost almost a year’s worth of payments towards PSLF when my payment should be at its lowest. Frustrating!

[William Durchholz @willdurchholz]

@orthotraumamd @orthobullets @DrBryanSaltzman @IU_Health @DavidTrofaMD @H2O_SportsMD @RachelFrankMD @DrDerekOchiai @txsportsdoc @DrDeCampos @DrDavidAbbasi @thekneedoc @DifeliceMD @DrBhatiaOrtho I myself have 2 hamstring grafts, but I think I plan on using patellar tendon grafts. Great case!

[William Durchholz @willdurchholz]

@orthobullets @CForsthoefel1 @IJBI @schulte_ss @stevemchale @rkh_md @DrFraneNicholas @itius @drsebheaven @ChrisGraysonMD1 @Dr_Stambough @yoon_rs @jointdocShields Interesting case. Would attempt closed reduction on ED under conscious sedation, post reduction CT, and boarding for exam under anesthesia.

[William Durchholz @willdurchholz]

@traumaticum @orthobullets @BrandonYuanMD @MayoClinic @FOTNorthAmerica Agreed with this approach, the joint won’t be the same again.

[William Durchholz @willdurchholz]

@orthotraumamd @orthobullets @my_cmh @vcpublichealth @rkh_md @itius @jamesablairMD @FractureDoc @stevemchale @eric_novack @DrFraneNicholas @bonesmith_ @schulte_ss @DrAJ26001405 This is an interesting case. I think using vanc powder during initial debridement may be worth while to iradicate infection prior to nail/plate combo. To determine resuscitation, trend lactate.

[William Durchholz @willdurchholz]

@orthobullets @mereddy_praveen @starhospitalsin @AAHips @stevemchale @rkh_md @DrFraneNicholas @itius @drsebheaven @ChrisGraysonMD1 @Dr_Stambough @tdd340 @jointdocShields @JoelMattaMD This case goes to show the importance of a tertiary exam. With this amount of shortening, I imagine reduction is difficult. I think THA is the best option for the patient despite his age given the length of time since injury.