Lawrence Stankovits, MD, FAAOS @DoctorLarryNJ
Pediatric Orthopedics. Jersey Shore and Middlesex County. atlanticpediatricortho.com New Jersey, USA Joined March 2020-
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@solimanibra92 @southNJscoli @Davembmd @pedihandsurgeon @bonesmith_ @Gnomelover1970 @MrDanPerry @CPOrthopedics This looks like a much younger child than 13.
@suhail_nasim Snowblower
@luinalaska W post
@DrNikhilMD Thanks for this refresher!!
@txsportsdoc Thank you for sharing this.
@IhabFathiSulima I saw this a while ago and do for every case. I don’t know why, but there’s a bonus of way less fogging.
@oatsdoc Comments like that are usually made by people who know just enough to be dangerous. My best preceptors in medical school (urban/suburban Cincinnati) were family practice docs who knew how to get sh** done.
@solimanibra92 @Davembmd @Gnomelover1970 @BucksHandExpert @CE_HandSurg @southNJscoli @FractureDoc @itius @rkh_md @pratikorho The procedure to take this down and refix is nearly as involved as osteotmy and invites more complications. I’ve pinned about 750 schfxs. A few have had lateral displacement and I’ve not had to osteotomize. However, the child’s age makes it a more difficult decision.
@solimanibra92 @Davembmd @Gnomelover1970 @BucksHandExpert @CE_HandSurg @southNJscoli @FractureDoc @itius @rkh_md @pratikorho Lateral displacement is remodeling, The lat Xray looks mildly extended/rotated. Not ideal, but not terrible. Slight valgus tolerated because not as cosmetically noticeable as varus. Take off cast, look at both arms with parents. I’d lean to leave it, but with an agreed upon plan.
@deln_ioann @Davembmd No operative get moving now. Might consider for highly competitive gymnast.
@deln_ioann I would not operate.
@deln_ioann It’s normal. I use 2.0 mm wires in kids this age, and unlike younger children, I keep the pins in a little longer like 4 to 5 weeks and start PT soon thereafter.
@Davembmd Simple hack- homemade slings on schfxs, esp. non-pinned, to prevent ext. force as the cast gets loosens. 3 ft of 2 in Stocknette with layered cast padding shoved inside where it sits on neck. Wrap each end around 4arm and knot to itself. Raise arm and flip over head while asleep
@Davembmd Spot on. There’s few things worse than someone else finding a late complication after you discharge a patient.
@deln_ioann @Davembmd I have succeeded a few times applying an esmarch and it lines up enough it pass. Feels good when it works.
@azhar_darokhan @InvictaOrtho @Ortho_Reviews @IndianOrthAssoc @bonesmith_ @pratikorho At this age I’d keep the pins in a little longer than usual, like 4-5 weeks. Most kids don’t need PT for this injury, but I start the older ones (10+) right away.
@Davembmd Gut says 2 years
@Davembmd Crayon drawn Thank You cards per year.
@IhabFathiSulima I include telangiectatic osteosarcoma on the differential for a lytic lesion to force myself to get advanced imaging immediately.
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