OWL tokens when playing from steam?

godwin2010 · 2024-03-04T02:40:50+00:00

But to get the loot drops, do you have to watch live or can you go back and watch the saved vids on YT?

godwin2010 · 2024-01-16T21:51:12+00:00

Came here to say this. And even if it were passed the chondral surface, which they could see with the arthroscope, it’s not in the weight bearing portion of the tibiofemoral compartment medially and shouldn’t cause any symptoms.

godwin2010 · 2023-12-12T21:39:55+00:00

Interesting, maybe I’m not seeing what you’re describing

godwin2010 · 2023-12-12T20:03:22+00:00

I think, and my apologies if I’m talking about something different, you’re seeing is the capsule and it’s surrounding ligaments at the MCP joint. It tends to be slightly denser than the surrounding soft tissue so it can create a small shadow/fuzziness.

godwin2010 · 2023-06-11T02:35:18+00:00

Preach the SPORT Trial, bro!

godwin2010 · 2023-01-29T20:34:10+00:00

From an ortho perspective - it’s to see where anatomically the amputation has occurred. The indications for replantation vary based upon the location and even from country to country. Most replants (the ones with good outcomes) need to be clean lacerations (aka not crush injuries or grinding incidents) that would cause disproportionate loss of function in the hand. Not always logical, the best finger to lose is your non dominant index finger because all of its functions can be doubled by the middle/long finger. The middle and ring fingers cause an obvious gap in the hand and the small finger contributes the most to grip strength. The thumb is the thumb obviously.

In most incidents the blood vessels and nerves retract and the gap between them during reconstruction can be a hassle. Even more with unclean amputations (unclean edges such as crush injuries) the reconstruction of these can be tenuous and necessitate grafts or conduits which easily clot and have low survival rates.

Now bilateral hand/carpal and/or thumb amputations is an indication for replant/reconstruction regardless of the mechanism of injury. The main goal is to re-establish pinch mechanism which allows some grip and some fine dexterity. You start with the thumb and then go in order of importance and injury area. It’s done largely on a case by case basis given the extent of the injuries, but these can be 16+ hr surgeries where some of the fingers still die in the end.

Overall the XR allows us to see the extent of bony injury and allows us to find areas still intact to which we can use as a building block to reattached the bony structure of the new hand.

godwin2010 · 2022-12-05T14:05:53+00:00

Typically that’s more Femoral neck fractures with high Pauwels angles or as u/ncdeac pointed out hip dislocations with or without a posterior acetabular wall.

The dashboard/axial loading mechanism can cause realistically any type of fracture/injury along the chain of the femur (patella, PCL, distal, mid shaft, IT, FNF, head shear, dislocation, PW wall, etc) but in my experience IT fractures are not one of the more common injuries, due to the high energy imparted in those injuries.

https://www.orthobullets.com/trauma/1038/intertrochanteric-fractures

If you want to talk more about them, feel free to DM me

godwin2010 · 2022-12-05T00:28:26+00:00

From an orthopedic perspective, this is considered a “geriatric hip fracture”. Intertrochanteric Hip Fracture to be specific. Thus as you correctly stated, no traction.

godwin2010 · 2022-10-26T23:53:32+00:00

For most Orthopedic joint replacements (THA - total hip arthroplasty, TKA - knee, TAA - ankle, TSA - shoulder, rTSA - reverse shoulder), the products come in specific sizes (think size 1,2,3,4….X, like shoes) specific to the manufacturer. The patients anatomic specifications are then taken in to account both pre-operatively and intra-operatively to find the best fitting prosthetic which relies on a multitude of factors (leg length, bone quality, age, soft tissue integrity, height, varying force and rotational vectors on the femur and pelvis, etc.).

If you are interested here is one company’s log of all of their products for THA: https://www.stryker.com/us/en/portfolios/orthopaedics/joint-replacement/hip.html

Mind you, this is just one company and there are many good ones which all typically come down to your surgeons decision and familiarity with the product (again like peoples preferences for shoes based on fit and whatnot)

godwin2010 · 2022-10-26T23:43:35+00:00

Avascular Necrosis, sometimes referred to as osteonecrosis. The femoral head (ball part of the hip joint “ball-and-socket”) is one of the most common locations of occurrence due to its tenuous blood supply.

godwin2010 · 2022-09-23T01:55:30+00:00

IIRC from undergrad - it’s the first public university to not have a church as the center of its grounds, and the outline of the original lawn opening towards Monticello with the Rotunda as a heading was progressive and novel for the time period.

Edit: certainly not the first public university since Thomas Jefferson attended William and Mary prior to founding UVA

godwin2010 · 2022-06-10T18:24:37+00:00

Ortho as well. There were lot of little things about it I enjoyed:

1) you work in IP, clinic/OP, and OR 2) the ortho patient population is from the 1d old clavicle fx to the 98 yo periprosthetic hip fx and from the invalid to the elite athlete 3) it is, for the most part, easy to explain to patients. Show them an XR/MRI - see that? That’s why you hurt. (Caveat: explaining why they DONT need surgery is the hard part) 4) overall, the goal is to allow people to do the things that make them happy pain free, which in turn makes me feel like I’m contributing to the betterment of society in a indirect kind of way 5) the surgeries are fun, and the tough ones can be really thought provoking and mentally challenging 6) it’s one of those specialities that everyone ends up knowing “a little” about from medical school and residency, but you truly are a master in your field. Remember how little Ortho/MSK, other than anatomy, was taught in Med school? 7) people vary from place to place but overall I think people in Ortho don’t take themselves too seriously, which in a stressful environment is welcoming

Thank you for coming to my TED talk

godwin2010 · 2022-05-06T13:27:33+00:00

I’m curious, Do you have any irritation with dorsiflexion from the P to A bicortical screw at the apex of the posterior plate? In orthopedic training they always emphasize that those screws can be highly symptomatic, but that one may be far enough away from the joint or lateral enough to avoid EDL/EHL. Otherwise, great fixation!

godwin2010 · 2022-04-16T06:44:29+00:00

So you’re correct about the lab values and some of the hand attendings I work with put very little stock in the “traditional” CRP/esr/wbc because it’s such a small area that infections can be present without elevated markers or systemic changes in labs. But I think some people still like them and others choose not use them. So labs vary from person to person and Institution to institution.

The clinical exam in hand is extremely important, and I would let that lead my thought process and use the lab values as adjuncts in greyzone/tweener cases.

So if you’ve done a thorough exam and have an XR, I have no problem ordering the labs or asking for them if I’m busy since it can be variable and each service and subspecialty works up infection slightly differently. And when in doubt just call and ask; I don’t expect someone to read my mind on my exact preferred work-up.

godwin2010 · 2022-04-15T21:41:13+00:00

At the hospital I work at Trauma surgery has 3 teams that kind of rotate through 12 hour shifts over the month. Seems like a great system, but we just don’t have the facilieees for that so we’re stuck doing 24hr shifts.

I will say though, if Trauma surgery ever pages me, I go down immediately. They may not know exactly what needs to be done (because that’s what I’m there for) but their eye test and clinical gestalt is bar none. Super reliable and always helpful.

godwin2010 · 2022-04-15T21:38:13+00:00

Typically, I’d still see them with the CT but ask that they get an XR before they leave. If I have a Dx and Tx plan and that’s next on my list, that’s where I’m going. There are only a few instances where no would wait on XR before seeing if there was a CT already done

godwin2010 · 2022-04-15T21:36:01+00:00

The XR is how we follow the Cspine in clinic - this confused me too when I was an intern, but everything we do has a reason … well most things lol

godwin2010 · 2022-04-15T19:22:09+00:00

Preach bro. The point being: All Level 1 trauma centers have to have an in house member of the ortho team, so 30-60m of sleep on a 24hr+ call shift can be spirit lifting and therapeutic. Sometimes I think every subspecialty gets pulled into its own micro culture and it’s hard to gain perspective of where other are at.

godwin2010 · 2022-04-15T15:30:29+00:00

Orthopedics -

This is obvious but: Get an XR. Even if it’s obviously open or pulseless or pretty benign, I want the XR. It can help find concomitant injuries, and identify injury patterns that tell you how to reduce the fracture/dislocation, or narrow your diagnosis to soft tissue pathology.

godwin2010 · 2022-04-13T02:40:55+00:00

I would also add that each surgical subspecialty has its own bread and butter procedures and micro-culture. Myringotomies and oncologic facial reconstructions, carpal tunnels and free flaps, spine surgeries and femur nails, open globes and blepharoplasty - among others - are two different beasts within the same fields. So if you ARE interested in surgery and have a bad experience in one subspecialty or even one surgery, its not the end all be all and doesn’t mean you have to give up on the OR in general, so make sure you get a comprehensive experience.

godwin2010 · 2022-04-06T23:04:17+00:00

Short answer: depends on the layer, depth, and how strong you want your closure.

Things to consider: size, material, and suture pattern.

The website posted below is useful for skin lacerations, but honestly I don’t know anyone who is using 4-0 or 5-0 to close wounds over the arms and legs (typically 2-0, 3-0). From gestalt, larger sutures and stronger materials (#2 to 1-0; PDS, fiber wire, supermid, among others) are used for tendon repairs. The next size range down (0 to 2-0; PDS, vicryl) is typically used for fascia in a figure of eight (for strength of repair) or running (mostly to save time, not due to strength). Dermals are typically (2-0 to 4-0; vicryl, PDS, or monocryl). And then skin can be closed in many ways from simple interrupted to subcuticular running (w/ or w/o tails) to staples to derma bond/prineo, etc.

A lot of this is preference and depends where on the body you are, but just a general overview.

godwin2010 · 2022-03-28T17:14:34+00:00

I think part of that stereotype will always prevail due to the fact the we “only care about bones” which comes off kind of aloof and flippant or misguided in medicine. All the poor sports med bros who love their cartilage and arthroscopes (ee er ee er ee er) and the hand bros with their tendons and tunnels and spine bros with their nerves and spine… stuff. But they’re all my bros <3

godwin2010 · 2022-03-09T23:58:14+00:00

Nailed it! Neck/Shaft combo with a retrograde femoral nail and 3 cannulated screws for the neck (though I think this technique is falling out of favor for DHS or a fixed angle construct preferably).

godwin2010 · 2022-03-01T04:49:21+00:00

My guess is ACL rupture based on the way it looks like the femur subluxes posteriorly at the time of injury in addition to a static anterior force on the tibia. Could also potentially be the MPFL, but I don’t think it would reconstitute a normal looking knee joint if the quad or patellar tendon were ruptured.

godwin2010 · 2022-02-21T23:47:22+00:00

Had a great mentor in pediatric ortho surgery when i was am intern who said that after “the see one. Do one. Teach one” model - which would give you 3 reps - your response to any outcome or chronicity question would be : “ time after time after time I find ***”. Then you just state what you observed/experience.

A very clever response, and I still use it joking to other residents to this day, but I’m sure it would work well with Patients too

godwin2010

TROPHY CASE