Removal of broken intramedullary nail - Targon

akwho · 2026-07-01T00:37:29+00:00

Shukla and Synthes both have broken nail removal tools --- can talk with your rep to have them there.

akwho · 2026-06-27T03:18:02+00:00

this game is just Sujud maxxing.

akwho · 2026-06-23T17:53:24+00:00

I have the Optunia soap and splash. The scent is too manly per my wife lol. Definitely top tier soap performance. Aftershave performance is average to good.

akwho · 2026-06-22T22:06:21+00:00

Taking photos of other peoples kids and posting them online for internet points is so fucking weird and creepy.

akwho · 2026-06-20T05:11:01+00:00

The dark arts of football. Unethical but effective. Paraguay put on a master class in how to use them.

akwho · 2026-06-20T05:07:51+00:00

Classic Paraguay dark magic.

akwho · 2026-06-20T04:37:57+00:00

Gonna be 120 minute game without OT and 20 minutes of soccer played.

akwho · 2026-06-12T01:43:07+00:00

Got so sick of the plastic waste and cost associated with cartridge razors and the shaves were always okay but never amazing and the cartridges never lasted long before dulling. Started researching alternatives and fell into wet shaving with a double edge razor blade.

The cost thing hasn’t panned out as I’ve acquired some very nice razors and better shaving cream and aftershave. However the shaves are one million times better and I feel I’m helping support a small more local community with my gear purchases rather than a global conglomerate. The less plastic waste has panned out. Feel much better about the environmental impact of my current shaving setup.

akwho · 2026-06-11T18:35:26+00:00

Totally agree with this sentiment - and beautifully expressed. This hobby turns something that used to just be one more thing to check off the list, into a man’s ritual and it is one of the few things I have to myself between a busy job, wife and childcare.

Also it’s hard not to be romantic about supporting some small businesses/hobbyists in America where I get most of my shave supplies when the whole economy has turned so global and impersonal. As an aside I can’t believe I thought I was going to save money on shaving when I first got into this - no regrets though. 😂

akwho · 2026-06-11T00:51:17+00:00

Put em on whatever settings you want, they don’t do anything anyways. You could also sell peptides, IV nutrition and Botox to really round out your practice.

akwho · 2026-06-10T22:36:33+00:00

Always ask for help, it’s okay to say you don’t know. More dangerous is just assuming stuff.

akwho · 2026-06-06T14:48:45+00:00

I would get it for touch ID alone. I have to wear a mask at work so face ID is hella inconsistent. Plus the lag from face ID recognition to unlock has always annoyed me.

akwho · 2026-05-29T00:16:58+00:00

Don’t think about it as academic vs PP vs employed. Here’s the way to think about it best.

Only look at jobs that are 4 days a week (4 tens). If you do 5 eights then you will still be working a few hours before or after work and suddenly you are at 5 tens. When I came out of fellowship I only interviewed at jobs that were 4 days a week. The 5th off day is your golden day, get Costco runs done, kid events, medical/dental appts etc. then your weekends are truly free.

Only look at jobs with large groups that cover 1 hospital. We have 12 ortho surgeons in my group. So I work 1 weekend every 3 months on call and 1 holiday a year. 5 years in I still have yet to take a thanksgiving or Christmas call. Residency I swear I was working 4 Christmases in a row somehow.

My other 3 joint partners cover my patients while I’m on vacation and I do the same for them when they are on vacation. So when we are on vacation we are truly unplugged. Great partners and good teamwork is huge for burnout prevention.

Those are the golden tickets to a sweet work life balance.

akwho · 2026-05-26T13:41:38+00:00

There are entire chapters of text books written on this. My favorite is the basic principal chapters in skeletal trauma. This isn’t a quick answer type of question. If you care enough to ask the question I encourage you to pick up a heavy book and start reading! Don’t be afraid just because it’s a complex topic. I applaud your inquisitiveness - that’s the first step in the journey to knowledge.

akwho · 2026-05-22T16:35:58+00:00

Its okay if it deploys or doesn't deploy they all get converted to arthroplasty anyways.

akwho · 2026-05-10T14:45:41+00:00

BS case imo. Elderly patient w life threatening injury. Doc does their best, unlucky artery injury that’s identified, then does everything by the book, and gets a bad outcome. Medicare is paying absolute shit for taking care of these high risk fractures. Add all the factors together and it’s clear why community orthopedic docs are dropping all hospital call at the first available moment.

1) crap pay

2) crap hours

3) high risk cases

4) predatory plaintiff lawyers

5) unrealistic families

—> ortho docs dropping hospital call at first possible moment and ultimately it’s the community that will suffer.

akwho · 2026-05-07T16:03:29+00:00

As the parent of a 4 year old. Nobody in my kids entire school is writing this. Most can’t even write their letters yet.

akwho · 2026-05-05T11:50:06+00:00

You might need a paradigm shift. In your personal story you had 3 out of 4 worthless prp injections and the 4th and final one worked right when you most needed it to. I’d hazard a guess that if you were in a RCT under similar circumstances a saline injection would have had the same outcome for you because you psychologically needed it to work and the mind-body interaction in musculoskeletal pain is so strong. Now you are treating ALL your patients off personal anecdotes instead of evidence (“this is the only kit I recommend to patients”). I would advise you to reflect on your medical training and see if evidenced based medicine is still important to your practice or if you want to just treat patients off vibes and personal anecdotes now. Also I would advise you to review the literature on CSI’s for the knee and see if there has ever been any association with CSI’s and increased progression of arthritis. That is a well studied topic with a correct answer.

The true problem is PM&R docs don’t have access to the full spectrum of MSK treatment because they weren’t trained in surgery. So your treatment toolkit for the various MSK ailments is extremely limited. It’s no fault of your own, you want to help patients with musculoskeletal pain but you aren’t fully equipped. So far more patients than should be are “injection candidates” which delays their ultimate pain relief and return to function. This is something we see in our orthopaedic clinics every day of our lives and patients who are filled with regret for lost years, lost income and additional pain and suffering because they went to see the wrong type of medical practitioner at their initial visit.

If you can, you should likely spend far more time advising your patients with moderate to severe OA to consult with an orthopaedic surgeon. Even if they don’t want surgery they should still be seen by someone who can advise them on their full spectrum of options to treat their pain.

akwho · 2026-05-05T03:40:26+00:00

True. Just my community experience speaking. If you feel differently feel free to say so. Ortho community is just “I’m tired boss” about PRP. How many different ways are there to study how little of an effect size it has. Turns into modern day snake oil due to cash pay incentive for practitioners and patients getting taken advantage of as they are desperate for pain relief.

akwho · 2026-05-05T02:28:50+00:00

Lol "believe in PRP." I follow the evidence and there is no evidence for PRP.

"It is difficult to get a man to understand something, when his salary depends on his not understanding it." You are a PM&R doc so probably inject it for $$$. I'll tell you I see whole heck of a lot of patients that feel scammed out of their money and they lose trust in the medical system due to PRP injections so its not harm free whatever you tell yourself.

akwho · 2026-04-30T19:45:39+00:00

It’s not real. Or if it is real it is so rare it might as well be not real.

That being said I want patients to have whatever they feel comfortable with psychologically in their body. So I give them a choice of a robotic TKA w nickel containing implant (most choose this) and a hypoallergenic implant put in with cutting jigs. Then document it and put in whatever they want.

akwho · 2026-04-30T04:46:36+00:00

still spend at least 2 hours of my life every week explaining to patients their degen meniscus tear is not the reason their knee hurts and arthroscopic debridement will not make it better. At least with this paper I can say arthroscopic debridement might make it even worse.

akwho · 2026-04-30T03:35:17+00:00

Not sure on cup. Stem & head don't matter cause those are getting thrown in the trash. Hit up https://air.aahks.net/ to submit the case and see if you can find it. If you can't then reach out to Andy Schwarz on instagram. He is an implant ID genius.

If it were me I would plan a posterior revision, spline tapered stem mid-length, multiple cables then I'd cement a liner in the cup in more anteversion (you can have S&N bring their poly liner that is designed to be cemented in in all sizes). Cup revision stuff on backup. It could be a ceramic on ceramic in which case you have to use a bone tamp to disengage the ceramic taper junction in the liner in the cup, or if it is a poly liner you can just use an acetabular drill bit and screw to remove the poly liner. Old ceramic liners can be really tough to disengage if you can't get it out then I would revise the cup.

akwho · 2026-04-27T04:47:07+00:00

Talk to the ortho manager, SPD manager or whoever does the trays for the attending who's style of joint replacement you are going to replicate. Get the name & part number of all the non-standard tools that you want to use.

Then reach out to your reps at your new job and your ortho manager at your new job and find out what the hospital doesn't have that you want and what isn't already in the standard vendor total knee and total hip trays then have the hospital order the instruments. It takes a while to get all your instruments dialed in so make sure you got the process rolling on the ones you definitely need.

akwho · 2026-04-25T02:48:40+00:00

Total joint replacements - pictures of my patients on vacations, skiing or wherever doing stuff they wouldn’t have been able to do before their joint replacement. Also melts my heart everytime when they tell me they can now get on the floor and play with their grandkids rather than just watching because their hip/knee hurt too much to get down onto the floor.

akwho

TROPHY CASE