Orthopaedic Writing & Publishing: Now and Into the Future
Vernon Tolo, MD
Editor in Chief, Journal of Bone & Joint Surgery
University of Southern California
Grand Rounds presented on March 22, 2012 at the O’Keefe Auditorium, Massachusetts General Hospital, Boston, MA
Orthopaedic Writing & Publishing: Now and Into the Future
What to do with Bunions? Better to leave them alone.
A bunion is a characteristically large bony bump at the base of the big toe. This alters the alignment of the bones, causing the base of the big toe to angle out and crowding the tops towards the smaller toes. Bunions can often be painful and cause swelling, making it difficult to find comfortably fitting shoes. The big toe pushing against the smaller toes can result in irritation of the skin, forming painful calluses.
Bunions occur more frequently in women and can occur in children as well. Although some footwear can contribute to the deformity, it is not the sole cause. “People who develop bunions often have an underlying predisposition to acquire them, such as a family member who may have them, overly mobile joints, or a disease such as rheumatoid arthritis,” explains Dr A Holly Johnson, Foot & Ankle Surgeon at the Massachusetts General Hospital and Instructor at Harvard Medical School, Boston, MA. Traumatic injuries to feet or toes can also result in bunions. Bunions can occur in people with flatfeet (or over pronation) and may involve deformities of the smaller toes, such as hammer toes.
Left: X-ray of normal foot while standing. Right: Foot with a bunion, also called hallux valgus. Notice the bony protuberance and the large angle at the base of the big toe. The top of the big toe is seen crowding towards the smaller toes.
Mitch Harris, MD, is Chief of the Orthopedic Trauma Service, at Brigham and Women’s Hospital, and Associate Professor of Orthopaedic Surgery at Harvard Medical School.
Here, Dr Harris shares a very useful algorithm for evaluating patients with trauma to the cervical spine.
Imagine getting called to the Emergency Department to evaluate a painful and swollen knee after a skiing accident. The plain x-rays are read as normal, with no evidence of acute fracture and demonstrate evidence of degenerative arthritis of the knee. If the patient is experiencing too much pain to allow for an adequate exam, a knee brace will be provided and the patient re-evaluated in the office in 7-10 days. If there is significant ligamentous injury, the brace will suffice for temporary stability and a follow-up MRI might be required to fully define the extent of the injury.
Now consider another presentation. This time the mechanism of injury is a fall from standing in an elderly woman and the area of concern is her cervical spine. The patient has a black eye, no history of loss of consciousness and complains of neck pain while in the collar. There are no other associated injuries. Plain x-rays of her cervical spine are read as normal, with no evidence of acute fracture and demonstrate evidence of degenerative arthritis of the neck. The questions now are: what should the next tests be, and can the patient be safely discharged in a collar for a follow-up appointment in 1-2 weeks?
Normal appearing Left and Right facets of the cervical spine from MD Computerized Tomography (MDCT) scan.
Grand Rounds presented on April 15th, 2010 at the O’Keefe Auditorium, Massachusetts General Hospital, Boston, MA.
Due to a recording error, the video does not pan over to Dr Heckman’s slides. To rectify, we have provided the complete set of Dr Heckman’s slides below. Thank you for your patience.
Dr Malcolm Smith, (Orthopaedic Surgeon at the Massachusetts General Hospital, Boston, MA has been providing valuable clinical service in Haiti. Read one of his email dispatches from Haiti.
You can read more dispatches from Dr Malcolm Smith here.
From Malcolm Smith, MD:
Sent: Jan. 20, 2:50 pm
Summary diary for today: Had a small disturbance this AM when limited visitors at gate to reduce numbers of people in the hospital. As you may expect a lot of care is given by families. Settled when interpreter and I explained to crowd. Was really only shouting pushing and a few fists and was improving when I got there. Completely calm since, have asked DC for UN security to maintain safety but feel OK.
Argentinian UN military stopped for short visit then left promising to come back, did not. No more trouble. Lots of people but calm. Have been offered help from Congressman Capuano ‘s office in DC. Sounds wonderful, hopefully can get supplies in to local soccer field by air. Expecting Akshay, our second anesthetist tonight and James, our own Hatian orthopedic resident, with more MGH nurses to fly tomorrow …
Working very well as a team ourselves, so impressed with these people. Have raided local warehouse for stores, found lots of unopened aid boxes, some gloves, drapes, etc. but will need surgical supplies soon. Discovered the only blood tests we can do is a crit and cross match. No facilities to do electrolytes. Problem with rhabdo patients so watching urine color and volume pushing fluid and diagnosing acidosis clinically …
Had to operate for a short time with head lights when power cut this evening … Finally about to do our first laparotomy as have Selwyn with us but being delayed by C section that just happened — our anesthetist helped baby looks fine. Life really just goes on.
Several of our colleagues have been providing invaluable service in Haiti in the aftermath of the earthquake. Below, we are excerpting a note from Dr George Dyer, (Orthopaedic Surgeon at the Brigham and Women’s Hospital), which will give you an idea of what has been happening in Haiti and the excellent service provided by our clinical staff.
You can read more about the Brigham and Women’s Hospital’s Haiti response.
From George Dyer, MD:
Today better email so taking advantage to send longer message.
At St Marc a town 90 min from PAP (Port-au-Prince) in what’s considered a large regional hospital. It is totally overwhelmed by patients.
Team includes several you would know– Malcolm Smith from MGH, Selwyn Rogers from BWH. Also 11 others including Partners-trained ER MD, MGH staff anesthesiologist, a private practice anesthesiologist who’s a frequent PIH volunteer in non-disaster times, an internist from NYC who is also Hatian, six RNs — two experienced critical care RNs running our PACU, two managing large unruly wards, one with prior disaster experience and Denise Lauria whom you might know from MGH and Faulkner who’s running our OR.
Things badly organized and chaotic when we arrived. While trying to be culturally sensitive we have essentially taken over like an invading army. For example OR had no functioning anesthesia machine though three broken ones. There are two OR rooms and a PACU by design but disuse and necessity had left one OR completely useless and PACU turned into disorganized storeroom.
George Dyer, MD, is an Orthopaedic Surgeon at Brigham and Women’s Hospital, and Instructor of Orthopaedic Surgery at Harvard Medical School. Here, Dr Dyer shares a useful trick for simplifying the delivery of allograft bone chips to a small graft site.
The conventional method of delivering bone chips into an area to be grafted typically involves plucking them out of a little bowl with forceps and trying to place them into the recipient site without spilling them everywhere. This often results in a mess: graft falls out of the forceps while en route to the surgical site, landing in soft tissues, on the drapes, or on the floor. Graft and time are wasted. This process is especially awkward when the recipient site is a small hole or window and the surgeon is attempting to pack the graft into it.