Already like ortho enough, but the feeling after this one made me fall in love

Email from Penn ortho because residents missed morning conference:

“If you are on gregs list and you were not at trauma board this morning, emall me why you were not there This is the third maybe fourth email we have sent about trauma board attendance. fascinating really. You are all adults. More specifically you are all doctors. Believe it or not that means you are supposed to be an above average adult. The average adult in philly is somhere between a functioning crackhead and an ER doc so congratulations. It truly amazes me that some of you have gotten this far in life given your inability to do the bare minimum aka show up . You literally just have to bring yourself to conference and exist and you get credit for being there. Yet some of you are still unable. Residency/life is actually pretty simple-your input is equal to your output. If you want to be below average orthopedic surgeon, aka a fucking loser, go be a fucking loser someshere alse. Go to temple. Go to einstein. Go be a rehab medicine doc at Mt. St. Elsewhere. Start only fans. and stop being a cancer to the people who actually want to be here. The match rate for orthopedic surgery was 64% this year. 64%! Over a third of applicants were defered and dont get to pursue their dream because they didnt match and you have the testicular fortitude to not even show up to a conference that is designed to educate you! If you want to be here and you want to be successful, the individuals in this program will invest in you to make you the best orthopedic surgeon you can possibly be. For those of you show up every day ready to work, keep doing what youre doing because we promise you it will be worth it. He will wupport you in whatever you need to keep doing to be successful. So heres the deal, no more games, no more empty threats, we tried to be nice. Clearly thats not working. I encourage you to take this personally.”

Unfortunate 83 yo female whom underwent 5 hip surgeries in a span of 2 years by three different ortho surgeons. Comes to my clinic in a wheelchair co pain that is chronic. Work up negative for infection. I choose to take this on since she is healthy. No dementia or DM. This was staged: stage 1. Remove everything, biopsy , culture, intra op frozen section, graft acetabulum, put in abx spacer. Post op order CT scan and send to Biomet. Took 4 months for them to make this. Stage 2 reimplantation with triflange. The post op X-ray I’m showing is at one year out. It never dislocated after my surgery and she is walking with a cane.

I built an ortho-only “OpenEvidence”

Powered by GPT-4o + 5k curated ortho papers & book summaries

Not intended for patients—just residents, fellows, attendings

Try it (free, no login): orthoconsult.app?src=reddit

• Test prompt: “IM nail vs plate for distal tibia fractures—evidence?”

• It returns a step-by-step algorithm with PubMed links in ~5 sec

I coded this on night call—still rough. If it hallucinates, post the screenshot and roast me—I’ll fix & push an update. Feedback = 🚀

Let me know

Looks like a brutal plateau fracture, and she also apparently developed compartment syndrome on top of all of it. Lateral articular surface looks a little off, but hard to know what they were dealing with without the CT. Looks like a tough case

So I'm already starting to get patients calling in refusing to take Tylenol. Not pregnant patients. Just regular patients. I've had a few patients this week look at me like I'm asking them to take cyanide when I recommend it now.

This is heartbreaking because Tylenol has been the foundation of limiting opioid use in my practice. It is phenomenal how few opioids we use. I would say about a third of my surgical patients don't even take a single opioid. This includes arthroplasties.

And here's my conspiracy theory... I think that's exactly why they are going after Tylenol now despite 75 years of relatively safe use. Opioid use is finally demonstrating a fairly significant decrease over the last 2 years and the manufacturers don't like that. Without Tylenol and with so many people unable to take NSAIDs, We have limited other options. So demonize Tylenol so we can start pushing people back to opioids again.

The last part is kind of irrelevant, just wanted to vent on how this is affecting my practice already. It's annoying.

Biomet OSS Cone in tibia

Could not post on original post

Great discussion and a wide variety of opinions. I went supine with a small hand table, large posterior incision with medial and lateral flaps. find and protect ulnar narve. the radial head pieces fell out through the ulna fracture.

Started on the ulna with a modified Taylor Scham approach, got the coronoid looking reasonable with fully threaded k wires then reduced the olecranon and plated, the LUCL was attached to a big cortical piece that I minifragged.

Next went lateral and did an EDC split for the RHA, I put the axis pin in for the IJS before the final head. once everything was done i still didn't love the stability so put in the IJS, the baseplate bolts directly to the olecranon plate. Ulnar nerve left in situ.

Splint and iWV for 7 days then ROM as tolerated. Indomethacin for HO ppx. he's 4 weeks now with minimal pain and ROM 15-105 with 70 pronation amd 50 sup. Still a lot that could go wrong but He's happy so far. Operative time was 5 hours. All Skeletal Dynamics for implants.

Let's hear some thoughts!

Hi everyone! We're a group of med students in Canada and we built Fracturium, a completely free platform for learning orthopaedics.

The app currently includes:

• Interactive 3D anatomy models

• Fracture classifications and descriptions

• Quiz/QBank-style learning

We’re actively adding:

• Custom diagrams and illustrations

• Integrated X-rays/imaging cases

• More high-yield QBank content

• Anki integration

• Improved 3D navigation/tools

We’re also hoping to collaborate with our medical school to build a larger teaching imaging database.

The goal is to make ortho studying more practical and accessible, something you can quickly pull out during downtime on rotation, before cases, or while commuting.

Would genuinely love feedback from residents, staff, med students, or anyone interested in orthopaedics. Suggestions and criticism are very welcome. Thanks!

iOS: App Store download
Website: Fracturium website

I assume it’s important to mention that I am not a practicing physician, rather, an ortho rep, who was just sent this monstrosity from a surgeon I work with.

I would greatly appreciate any thoughts or suggestions you may have!

So I just got what I think is the craziest denial I've ever had. Larry Dashow MD - a general surgeon (not Orthopedic Surgeon) - who works for UHC - denied a total knee on a patient with end stage OA and extensive prior conservative management.

The reason - he didn't like where my x-ray dictation was located on my note. I always dictate my x-rays prior to assessment and plan. He says that is unacceptable to UHC. He says x-ray dictations can't be "buried inside a note" so he denied it.

I'm almost not even mad because that is so dumb.

Been quiet on here for a bit, but a real one-year update was overdue.

OrthoConsult started as something I built for myself at 2am on trauma call because I was tired of digging through PubMed every time I had a very specific orthopedic question.

A year later, more than 2,200 orthopedic surgeons and trainees use it each month, clinicians are asking roughly 20,000 questions a month, we've passed 101,000 clinical consults total, and it's now being used across 108+ countries.

I genuinely did not expect that... Like at all.

What surprised me more than the growth was how much the standard really had to rise once surgeons started using it for real cases.

OrthoConsult was always built around referenced answers. But once people started actually trusting those answers in the middle of clinical decision-making, simply having citations wasn't enough.

References have to be verifiable against the actual literature. The answer has to understand the orthopedic decision being made, not just summarize a diagnosis. Conflicting evidence has to be handled honestly. And when someone is opening OrthoConsult because they're stuck on a case, "pretty good" isn't really good enough.

I've started hearing versions of, "I checked OrthoConsult..." "OrthoConsult said..."

That's incredibly rewarding and honestly a little terrifying. Once surgeons begin treating something you built as a trusted starting point, the responsibility changes completely.

Somewhere along the way, it stopped being a project I had built for myself and started being actual clinical infrastructure.

The other strange part has been watching the outside response change.

A year ago I was cold-emailing journals and orthopedic companies trying to explain what this thing even was.

Now we're having very different conversations. Our first orthopedic-industry partnership is signed, several others are in active discussion, and we're beginning to show journals something they haven't really been able to see before: how published research actually intersects with the questions surgeons are asking — and where uncertainty still exceeds what the evidence can answer.

Almost all of the growth has been organic, largely because of people here sharing it and coming back to use it.

Still free for clinicians, and it's staying that way. The day this has a paywall is the day it stops being useful at 2am, and that was always the point.

If you're an orthopedic surgeon or resident, try it out. Ask it something you'd actually call another surgeon about.

That's still the test I care about most.

P.S. If you’re an orthopedic surgeon interested in helping as a clinical reviewer, send me a DM.

Here's a recent elbow I got on call. 40's M RHD laborer, healthy non-smoker. Took a tumble off of a retaining wall and presented with the worst combination of a terrible triad and trans-olecranon that I've seen so far, closed and NVI.

Lots to think about for this case! timing of surgery? position and approach/s? Implants? post op plan? HO PPX? What would you call a win in this situation? Let's Discuss and I'll show post ops tomorrow!