Orthopedics can be complicated. Thankfully, Dr. Hal Dole, after passing his IM boards also completed a Fellowship in: Optimization, Restoration, Transition and Hyperalimentation of Organ Malfunction Emanating from Surgical Sequelae and Surprises: ORTHO-MESSS. There, he learned to use the word “fracture” instead of “broken” and bench-pressed 250lb.
Here’s his take on Intratrochanteric Hip Fracture:
“There are bones in the leg, you see. One above the knee and two below. Strange I know. Lower down, it’s all bones. Like maybe 80 of them. I think there is a special school where you can learn all their names. There are muscles and tendons too.”
“Usually bones are not broken. But sometimes, they are. You can tell if a bone is broken when it sticks out of the body. But bones can be tricky and be totally broken inside the leg. We have X-rays for that.”
“When I have a patient with a broken bone, you see: I get a detailed history, EKG, Echo, Labs. Social History, Family History, check lipids, Thyroid… gotta check thyroid. I found an insulinoma once. Do a full neuro exam. Make sure you get a full Review of Systems. Cortisol level… that never hurts. Iron studies? I never regretted getting those. Get an ultrasound of something… Kidneys maybe. I get X-rays too if I don’t forget. Then I call the orthopedic guy. The patient disappears from the floor for a while and comes back all fixed! EBL<50! Tricky stuff these bones…”