Late-night, End of Rotation Studying

I am up late reading about metacarpal fractures. I was worried that I would have trouble studying in sleep-deprived mode during residency, but I think I can hack it if it's ortho related. This stuff just clicks in my mind. It's so much more concrete than the rest of medicine, and holds my attention better. I'm nearing the end of this month, and it looks like I won't get the time I had hoped to recover from the drive back home. I'll be starting an emergency medicine rotation two days after I get home, and the kicker is it'll be 50 miles away from home. Thankfully, I was able to set up free housing in the area so I won't have to commute the full distance.

I've seen some interesting knees lately. If you don't know what the typical radiographic signs of arthritic change are, you should look them up. Osteophytosis, sclerosis, subarticular cysts, and joint space narrowing are the four big ones, and I've seen these pretty bad of late as my attending is a big knee and shoulder guy. One young adult patient in particular had a nasty case of bilateral arthritis, the severity of which normally wouldn't set in for another 30-40 years. Another doctor had recommended moving straight to knee replacement, but the patient didn't want to use that drastic of treatment right away. This patient came to clinic for a second opinion and my attending explained that usually there is a progression in treatment from conservative measures like steroid injection, physical therapy, viscosupplementation, and bracing, to more intermediate treatment with arthroscopic surgury and "cleaning out" the joint, to more radical treatment like knee replacement. The pateint appreciated this approach a lot more and understood that conservative measures may fail, but we could cross that bridge when we come to it. My attending said some patients come in and can't be talked out of knee replacement, so he's willing to do that, too if it's indicated. You can't force a patient to adhere to a certain treatment regime, so matching the proper management with each patient is part of the art of medicine. That sounded less cheesey in my head.

I was thinking a bit ago that as I progress in my medical career, anything I distribute publicly can be taken as medical gospel and cause liability for me,which I would like to reduce when possible. Hence the ugly disclaimer at the top of the page.

Hopefully I'll have some more ortho cases to post about and maybe some ER cases before my next newsletter.

Scott