The top left x-ray of the elbow is normal. The top right x-ray of the elbow has an occult fracture of the radial head. An occult fracture is when you cannot see the break on an x-ray. How did I know the radial head bone was broken if I couldn’t see the fracture line on the x-ray????

Answer: the bottom image has the positive “fat pad sign.” This anterior and posterior fat pad sign is circled in red. The soft tissue shadow located on the front and back of the elbow bone indicates that there is blood in the elbow joint. The fat pad which normally sits adjacent to the bone is not seen on a normal x-ray.

Do I have scoliosis? This is a question I get asked fairly often when people come in with back pain.
Scoliosis is when you have a curvature and a rotational deformity of your spine. By definition the curvature of the spine should be at least 10°.

You can develop it as a child with the etiology (most commonly genetically related) or as an adult secondary to arthritis. Treatment is based on the age of onset and the degree of the curve. It can range from simple observation, bracing, to complex invasive surgery.

The image with the blue S curve is a patient with scoliosis and the image with the straight green line shows a normal spine.

This is a condition where your kneecap is tilted and compresses on the femoral groove abnormally. Imaged below is a picture of a kneecap joint with lateral patellar compression syndrome. You can see where on the right side the bones are touching each other and on the left side there’s a big open space. There should be an even space on both sides.

This picture shows how the kneecap looks after I have performed a lateral release. This should give the patient almost immediate pain relief. This is a diagnosis sometimes difficult to figure out because there is not a great imaging modality to document. Many times it is more of a dynamic problem and cannot be statically imaged.

Seeing all kinds of cool orthopaedic stuff! Today we have the privilege of treating one of our University of Louisville Women’s basketball team season ticket holders. She was giving us the scoop on the U of L vs U Conn win. So proud of our lady Cards!!!

You would think in this day and age of high technology we would have something more technologically advanced to reduce a fracture in the operating room. However, we still use old-fashioned bone reduction clamps to hold the broken bones together while we are fixing the fracture. Imaged below are two different bone reduction clamps that I commonly use. The one on the left is called a point to point and the one on the right is called a lobster claw.

How do we accurately place screws in the knee and shoulder joints when we are using an arthroscope or even in some open surgeries?

We use a technique called cannulation. A guide pin, which is quite small and commonly around 3 mm in diameter or smaller, is placed. If the guide pin is not in a perfect position it is not a big issue to readjust the guide pin and make a second entry side into the bone.

Then we use the appropriate size drill over the guide pin. So the drill is hollow therefore the guide pin can fit through the drill. After the drill is removed from the bone, the guide pin is left in the bone. The screw is also cannulated or is hollow. The screw gets placed over the guide pin, the cannulated screwdriver is seated into the screw head, and the screw is placed. This allows accurate placement within the bone. The drill bits are also marked with measurements so we know how deep the drill is going into the bone.

These images show a cannulated drill bit:

1. When ramping up your mileage do not increase your mileage more than 10% per week.
2. Listen to your body. If you start to have pain, you need to back off and increase your cross training activities.
3. Keep a detailed training log. A training log is also very useful if you get a stress fracture so you can go back and see what caused the stress fracture activity wise. You will not want to repeat that in the future.
4. Check your vitamin D levels. Have your  primary care physician check those levels. You would want them to be between 50–60 as an athlete .
5. Mix up your training surfaces and activities. It is a repetitive force on the lower extremity that can cause a stress fracture. By mixing up your training surfaces and activities you will apply different forces to your feet and your lower extremities, which will decrease the repetitive force to the pelvis, hip, legs and feet.