@scrollmed_etgOrthopaedics
eTG Antibiotic (August 2026 update): Septic bursitis@scrollmed_etgOrthopaedics
eTG Bone and Metabolism: Osteoporosis and minimal-trauma fractureThe army surgeon who invented the cast
Plaster casts are younger than the stethoscope. Antonius Mathijsen, a Belgian army surgeon, introduced plaster-of-Paris bandages for fractures in 1852, changing how broken bones were held still.
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The Classic: New method for application of plaster-of-Paris bandage. Clin Orthop Relat Res 2007The rule that cut ankle X-rays
The Ottawa ankle rules were built from 750 adults with ankle injuries at two Canadian emergency departments. In the original study, the rules picked up all 70 significant malleolar fractures, so many patients could safely skip the X-ray.
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Stiell IG et al. Ann Emerg Med 1992;21:384–90For IV treatment of suspected MRSA septic arthritis of a native joint, which drug does eTG prefer?
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eTG Antibiotic (March 2025 update): Changes impacting multiple topicsWhich intervention is strongly recommended for people with knee or hip osteoarthritis?
@scrollmed_auOrthopaedics
RACGP: Knee and hip osteoarthritis—summary of recommendationsWhich description best matches a Colles fracture?
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NSW Emergency Care Institute: Colles fracture@scrollmed_auOrthopaedics
RCH Orthopaedics: Perthes disease@scrollmed_auOrthopaedics
healthdirect: Compartment syndrome@scrollmed_auOrthopaedics
RACGP/Healthy Bones Australia: Osteoporosis guideline, 2024After a limb injury, pain is unexpectedly severe and poorly controlled by analgesia. Which diagnosis needs urgent consideration?
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healthdirect: Compartment syndromeThe famous splint statistic is disputed
The Thomas splint is often credited with dramatically reducing deaths from femoral fractures during the First World War. A historical review found that publications disagree about the actual reduction—a reminder that famous medical statistics can have uncertain foundations.
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Henry BJ, Vrahas MS. The Thomas splint. Questionable boast of an indispensable toolA child has suspected osteomyelitis despite a normal early X-ray. Which imaging test does RCH prefer when symptoms are localised?
@scrollmed_auOrthopaedics
RCH Clinical Practice Guidelines: Bone and joint infectionLoading turns down a bone brake
In experimental bone loading, osteocytes reduced production of sclerostin, a protein that inhibits bone formation. Regions exposed to greater strain showed a larger reduction, suggesting bone can tune its response locally rather than acting as one uniform structure.
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Robling AG et al. J Biol Chem. 2008;283:5866–5875@scrollmed_auOrthopaedics
RCH Clinical Practice Guidelines: Ankle sprains@scrollmed_auOrthopaedics
RCH Clinical Practice Guidelines: Pulled elbow@scrollmed_auOrthopaedics
healthdirect limb injuriesA child has suspected septic arthritis. Which management principle is correct?
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RCH Clinical Practice Guidelines: Bone and joint infection@scrollmed_auOrthopaedics
RACGP/Healthy Bones Australia: Osteoporosis guideline, 2024Ultrasound shows a hip effusion in a limping child. What can this finding alone tell you?
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RCH Clinical Practice Guidelines: The limping or non-weight bearing childAfter a limb injury, what is the danger of rising pressure in a closed muscle compartment?
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healthdirect compartment syndromeA child with a supracondylar fracture has a pale, cool hand and an absent radial pulse. What is the priority?
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RCH Clinical Practice Guidelines: Supracondylar fracture of the humerusSUFE is suspected in an adolescent. How should they mobilise while awaiting orthopaedic assessment?
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RCH Clinical Practice Guidelines: Slipped upper femoral epiphysis@scrollmed_auOrthopaedics
RACGP: Knee and hip osteoarthritis—summary of recommendationsAcute compartment syndrome threatens perfusion
In acute compartment syndrome, injury-related bleeding or swelling increases pressure within a muscle compartment. Because the surrounding fascia has limited stretch, pressure can compromise blood flow and cause permanent tissue injury without urgent treatment.
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healthdirect compartment syndromeA child has a confirmed distal radial buckle injury with intact cortices on both views. Which plan matches RCH guidance?
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RCH Clinical Practice Guidelines: Distal radius and/or ulna metaphyseal fracturesA patient needs to stop denosumab. Which plan follows the osteoporosis guideline?
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RACGP/Healthy Bones Australia: Osteoporosis guideline, 2024A toddler stops using an arm, holds it pronated and has no swelling or deformity. No pull was witnessed. Which statement is correct?
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RCH Clinical Practice Guidelines: Pulled elbow@scrollmed_auOrthopaedics
ACSQHC: Hip Fracture Clinical Care Standard, 2023@scrollmed_auOrthopaedics
RCH Clinical Practice Guidelines: Supracondylar fracture of the humerus@scrollmed_auOrthopaedics
ACSQHC: Low Back Pain Clinical Care Standard, 2022A person over 50 sustains a fracture after falling from standing height. What should this trigger?
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RACGP/Healthy Bones Australia: Osteoporosis guideline, 2024Osteocytes can remodel their own rooms
Osteocytes are not merely cells trapped inside bone. During reproductive cycles, they can remove and later replace mineral around their own lacunae—a form of local remodelling distinct from the familiar surface work of osteoclasts and osteoblasts.
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Wysolmerski JJ. Osteocytes remove and replace perilacunar mineral. Bone. 2013@scrollmed_auOrthopaedics
RCH Clinical Practice Guidelines: Scaphoid fracturesA calcium-binding molecular helix
Osteocalcin contains specialised Gla residues that help it bind bone mineral. Their arrangement in a calcium-dependent helix supports attachment to hydroxyapatite: the protein's shape helps connect bone's organic matrix with its mineral component.
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Hauschka PV. Haemostasis. 1986A force sensor inside bone cells
In an osteocyte cell-line study, mechanical stretch lowered expression of the sclerostin gene through a Piezo1–Akt pathway. Blocking or removing Piezo1 prevented the response: a molecular force sensor helped translate stretch into a bone-regulating signal.
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Sasaki F et al. Biochem Biophys Res Commun. 2020;521:806–813Which ankle fracture may be suitable for treatment with a cast or walker boot rather than surgery?
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healthdirect: Ankle fracture surgeryAntlers are a regeneration laboratory
Deer regrow antlers annually, offering a model of organ regeneration in mammals. Researchers mapped the cells involved and identified a progenitor population arising during regrowth—not simply ordinary adult bone expanding.
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Qin T et al. Science 2023;379:840–847After assessment, a patient has low back pain without features suggesting serious pathology. What is the usual imaging approach?
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ACSQHC: Low Back Pain Clinical Care Standard, 2022Low bone density may echo in the ear
A study comparing people with normal bone density, osteopenia and osteoporosis found altered middle-ear mechanics in the low-density groups. However, conductive hearing loss was not more frequent—abnormal mechanical measurements did not translate neatly into that hearing-loss category.
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Changes in middle ear transmission secondary to altered bone remodellingAfter initial care for an uncomplicated ankle sprain in a child, which approach supports recovery?
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RCH Clinical Practice Guidelines: Ankle sprainsAn adolescent has knee pain, an out-toeing gait and obligatory external rotation during hip flexion. Which diagnosis fits best?
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RCH Clinical Practice Guidelines: Slipped upper femoral epiphysisBone makes a vitamin K protein
Vitamin K biology extends beyond clotting. Osteoblasts produce the vitamin K-dependent protein osteocalcin, and a small fraction enters the bloodstream instead of remaining in bone. That makes circulating osteocalcin a window into bone metabolism.
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Lian JB, Gundberg CM. Clin Orthop Relat Res. 1988Which feature should raise concern for inflicted injury when assessing a child's fracture?
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RCH Clinical Practice Guidelines: Child abuse@scrollmed_auOrthopaedics
NSW Emergency Care Institute: Colles fractureThe splint that changed jobs
The Thomas splint began as a way to correct lower-limb deformity, not as battlefield fracture equipment. Its role evolved through both World Wars, while its basic design changed little from Hugh Owen Thomas's published description in 1875.
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Robinson PM, O'Meara MJ. The Thomas splint: its origins and use in traumaHip replacement needed a friction fix
John Charnley's contribution to hip replacement was not simply a new metal joint. His low-friction approach combined polyethylene with acrylic cement fixation, tackling wear and implant stability as well as the painful joint itself.
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Phalak et al. Cureus 2024;16:e68832Milk borrows calcium from the skeleton
During breastfeeding, maternal bone supplies much of the calcium needed for milk. This mobilisation is not simply switched off by greater dietary calcium intake. After weaning, the skeleton normally rebuilds its previous mineralisation and strength.
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The puzzle of lactational bone physiology. J Clin Invest. 2019@scrollmed_auOrthopaedics
RCH Clinical Practice Guidelines: Bone and joint infection@scrollmed_auOrthopaedics
ACSQHC: Hip Fracture Clinical Care Standard, 2023@scrollmed_auOrthopaedics
RCH Clinical Practice Guidelines: Bone and joint infectionSpace station life thins the hip
A study of International Space Station crew found that cortical mineral loss at the hip occurred mainly through thinning from the inner bone surface. Spaceflight bone loss was therefore not just a uniform reduction in density.
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Lang T et al. J Bone Miner Res. 2004;19:1006–1012An adolescent has snuffbox tenderness after a fall, but initial scaphoid radiographs are normal. What is the best next step?
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RCH Clinical Practice Guidelines: Scaphoid fracturesWhich mechanism most commonly produces a lateral ankle sprain?
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healthdirect sprained ankleYou're all caught up
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