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I posted this case to discuss the "not so simple" ankle fracture with you all. A lot of you wanted to get the CT scan.... which shows us that this isn't so straight forward. .
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Look back at the injury films and then the CT. Wagstaffe- Le Forte tubercle like whoa! I'll be honest with you... I didn't know what that was until late in residency! But Hot Damn! I'm not letting any of you get away without learning what it is and why it matters. And it's presence here changes the entire plan.
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If you had a keen eye you saw it on X-ray. If not on X-ray, surely CT. Also have a segmental posterior malleolus. Makes the sequencing difficult! .
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Prone, posterolateral will get you the posterior mal (at least the lateral segment) and the fibula. You can go posteromedial too to get the medial segment for the posterior mal.... but what about the Wagstaffe tubercle? Can't get that prone and can't get that thru the posterolateral approach... so the plan if f'ed. .
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Supine, posterolateral for fibula and an accessory small anterolateral for Wagstaffe tubercle. Then prone posteromedial for segmental posterior mal, then supine again for medial mal. A lot of work and a lot of time changing patient position? Yes. Worth it? I'd say yes. This is a technically difficult case. Load the boat in your favor here. .
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Alternative would be starting prone and doing posteromedial for posterior mal and then going supine for fibula/Wagstaffe and then medial mal. The advantage is one less position change. The disadvantage is not getting the ligamentotaxis from the fibular reduction for the posterior mal reduction. .
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Some may say all supine for the pl, pm approaches. I say, of you can do it, awesome. I can't. .
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Do what you do to get it perfect. Plan for it. Stack the deck in your favor. Don't take short cuts. .
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#ortho #trauma #surgery #orthopedicsurgery #broken #ankle #brokenankle #anklebreaker #orthopedics #surgeon #surgeonlife #think #plan #anticipate #art #science #medicine #xray #execute #skateboard #skateordie #skateboarding #skateboardingisnotacrime #jobsecurity #premed #medschool #residency #ilovemyjob

1 Week to the World Championship 🏆🇰🇼
LOADING...🔋
#RoadtoMaui 📸: @yaalothman

Did you know that ?
•Make sure to follow @world0ffacts for more interesting facts like this and turn on the post notifications !!!!
Source - https://thoughtcatalog.com/jacob-geers/2016/04/really-funny-random-weird-facts/
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Thank you to everyone who participated in my #goalwriting 🎉 party!!! It was a HUGE SUCCESS & everyone walked away feeling fulfilled 🤗 I can't wait to see everyone's goals come to fruition 💸✈️📝🎉🙌🏿

TRY THIS CALF EXERCISE!
👉🏻Rest a plate, or two, or three... On your knees whilst crouching down.
👉🏻When you push up, lift your bum upp off your ankles.
👉🏻Hold as many reps as possible.
👉🏻When you cant hold them at the top anymore, then simply stay seates and push the heels up off the floor and contract the soleus/achilles.
🙋🏻‍♂️BURN IT TILL YOU CANT MOVE ANY MORE!
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Okay, go #Execute
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Super duper excited about this new pilot project!!! Was inspired by a video that went viral a few months ago... can you guess what we're doing? More pictures coming soon!!! #soexcited 🤗 #hkpilotprogram #dreambig #invision #execute

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McNabb was convicted of killing Montgomery police officer Anderson Gordon, shooting him five times as he sat in his patrol car after arriving at a traffic accident McNabb caused while fleeing a bail bondsman.

The U.S. Supreme Court says Alabama can execute a man convicted of killing a police officer two decades ago.

Justices on Thursday evening denied a request for a stay from 40-year-old Torrey Twane McNabb. The court had delayed the execution for more than two hours to consider the request.

McNabb is scheduled to be executed Thursday evening.

His attorney’s unsuccessfully sought to halt the execution since McNabb is one of several inmates in an ongoing lawsuit challenging the humaneness of the state’s lethal injection procedure.

Prosecutors say McNabb shot Gordon five times as the officer sat in his patrol car after responding to a traffic accident McNabb caused while fleeing a bail bondsmen.






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Both these guys with solid contributions off the bench for SMC. Will you be ready when the coach gives you the nod? #trainhard #mindright #focus #execute

Working while working is the most efficient way to working. -Confucius .... trying not to be "that guy" on set between shots. ------------------------------
#work #drive #passion #livewhatyoulove #dream #execute #humble #artist #creator #mysimplechanges #actor #commercial #neversettle

Hustle Hat Trick!!! Sent a felt pouch prototype to a hotel chain that's opening a new 200-room hotel in NYC, sold some lights on eBay, and sold more lights through the eCom site. #sidehustle #hustle #ecommerce #alwaysbeshipping #execute #stayhungry

A CONAP planeja e coordena os investimento do seu empreendimento com exatidão e aplicação.

It's crazy that some ppl don't realize this! All barriers in life are mental and to succeed all you have to do is execute, execute, execute!!! #leadership #hustle #uncompromising #studentsenate #college #minnesota #inspiration #work #grind #action #execute #mission #government

If you love what you are doing, you will be successful.✨💰
What do you guys think?💭💭
Comment below👇👇👇
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#boom #done ! 7 days of #fasting & waking up at #430am . #disciplineequalsfreedom #productivityhack . Celebrated with massive #cheatday 🙋‍♂️ #execute #getafterit ✌️

Mental Monday's
Create your own path, and Conquer shyt! That's it!

#push #execute #absolutestrength #conquer #leaveyourmarkontheworld #likethat

Porque todo esforço tem uma recompensa!

I just have no interest in it all. Be confident enough to show love but choose quality of quantity.
#framexframe #whatelse

It blows my mind that more B2B companies aren't advertising on Facebook 🤤...What's your experience with B2B on Facebook?

Think twice before you act!!
Do always the right thing!! Double tap if you like the post!

#imageoftheday #knowledge #begood #nevergiveup

Learn to love the process. #WadesWorld 🌎

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