Shoulder Arthritis / Rotator Cuff Tears: causes of shoulder pain: Failure of anatomic total shoulder joint replaceme...

Shoulder Arthritis / Rotator Cuff Tears: causes of shoulder pain: Failure of anatomic total shoulder joint replaceme...: One can always learn from studying failure. The study of planes that crash is more educational that the study of planes that land on time. ...

A true healthcare reform is needed. The cost of defensive medicine

"Jackson Healthcare, a healthcare solutions company, surveyed physicians on defensive medicine practices between October 2009 and May 2011. Their survey found that between 73 and 92 percent of all physicians practice some form of defensive medicine, at a cost of between $650 to $850 billion dollars in unnecessary expenditures, accounting for between 24 and 36 percent of our nation’s $2.5 trillion annual healthcare bill."

"A Bullet in the radial head"

Violence and gunshot wounds are a very concerning social phenomenon of our era. A teenager presented with a gunshot wound to the elbow. The entry side was to the lateral aspect of the elbow and no exit wound was found. There was no vascular or nerve damage as the bullet went into the radial head through the Kocher interval. On exam there was limited motion in forearm rotation. Initially, the family was consulted against removal of the bullet. The family insisted to have the bullet removed after explaining risks and benefits of the procedure. The main concerns were (1) AVN due to the trauma (2) Removal of the bullet could lead to collapse of the radial head and eventually radial head excision.

Alternatively, radial head replacement could have been performed, however the risks of capitellar arthritis in the midterm are significant after such procedure.



Treatment consisted of removal of the bullet which demonstated that the radial head was stable.

 Unfortunately, over the course of months the patient developed
(1) AVN, collapse of the head,
(2) limited forearm rotation

The patient was eventually treated with radial head excision.

His course was complicated by a synovial fistula that was repaired.

XR at the time of injury

XR at the time of injury

Postoperative XR after removal of bullet

Postoperative XR after removal of bullet

4 months after removal of bullet there is collapse of the radial head with loss of normal contour

4 months after removal of bullet there is collapse of the radial head with loss of normal contour

4 months after removal of bullet there is collapse of the radial head with loss of normal contour

Radial head excision

Radial head excision