dave
@davembmd.bsky.social
Pediatric Orthopaedic and Spine Surgeon In Phoenix Arizona. Father of 4. Grandad. Surgical innovation. Additive prototyping. Woodwork. Applied regression analysis. Author. Curious.
Closed Pediatric tibia fractures (in toddlers & younger) can be treated safely in boots or observation (if stable).
The evidence supporting this statement has evolved in a “less is more” trajectory recently because the fracture is stable because of the thick structual periosteum in young children.
The evidence supporting this statement has evolved in a “less is more” trajectory recently because the fracture is stable because of the thick structual periosteum in young children.
February 11, 2026 at 6:06 PM
Closed Pediatric tibia fractures (in toddlers & younger) can be treated safely in boots or observation (if stable).
The evidence supporting this statement has evolved in a “less is more” trajectory recently because the fracture is stable because of the thick structual periosteum in young children.
The evidence supporting this statement has evolved in a “less is more” trajectory recently because the fracture is stable because of the thick structual periosteum in young children.
2026 BBFA N=410; FU n=316 (77%), mean7.2y. Sec disp: distal 50/212=24% (accept31); dia 60/198=30% (accept49). def=≥15° pro-sup loss∨QuickDASH≥20. Accept sec disp ≡ no Δ fxn/rads vs aligned. Risk distal: complete radial disp+re-fx+bicort ulna; dia: ↑age ⇒ ↑ROM loss. tolerate sec disp esp distal <10y.
February 11, 2026 at 12:47 AM
2026 BBFA N=410; FU n=316 (77%), mean7.2y. Sec disp: distal 50/212=24% (accept31); dia 60/198=30% (accept49). def=≥15° pro-sup loss∨QuickDASH≥20. Accept sec disp ≡ no Δ fxn/rads vs aligned. Risk distal: complete radial disp+re-fx+bicort ulna; dia: ↑age ⇒ ↑ROM loss. tolerate sec disp esp distal <10y.
When I wanted my kids to practice piano, I taught them to love music. When I wanted my residents to pre-op plan; I taught them to love good long-term outcomes. As it turns out, this is the secret to rallying the troops in all contexts.
February 8, 2026 at 3:56 PM
When I wanted my kids to practice piano, I taught them to love music. When I wanted my residents to pre-op plan; I taught them to love good long-term outcomes. As it turns out, this is the secret to rallying the troops in all contexts.
Find me at AAOS this year and you too will be able to attest that I am so boring, unimpressive and uncharismatic that you’ll know the crazy stuff I say on here is intrinsically true
February 7, 2026 at 8:03 PM
Find me at AAOS this year and you too will be able to attest that I am so boring, unimpressive and uncharismatic that you’ll know the crazy stuff I say on here is intrinsically true
There’s nothing quite like the unique experience in modern times of playing age of empires on a steam deck in the same row and seat as somebody frantically working on a presentation or research on Excel, who’s going to the exact same conference.
February 5, 2026 at 2:55 PM
There’s nothing quite like the unique experience in modern times of playing age of empires on a steam deck in the same row and seat as somebody frantically working on a presentation or research on Excel, who’s going to the exact same conference.
Dawn's incandescent belligerence assails my dilapidated vessel of mortality, yet from the bruised threshold of my waking, I dispatch these cordial overtures in thy direction.
February 4, 2026 at 1:48 PM
Dawn's incandescent belligerence assails my dilapidated vessel of mortality, yet from the bruised threshold of my waking, I dispatch these cordial overtures in thy direction.
The sun's traverse has extracted its pound of cellular currency, compelling my retirement to the somnambulant chambers where consciousness dissolves into recuperative oblivion.
February 3, 2026 at 4:38 AM
The sun's traverse has extracted its pound of cellular currency, compelling my retirement to the somnambulant chambers where consciousness dissolves into recuperative oblivion.
Many residents look at pre-op planning as “scut work”. It’s not, but it’s extra work for sure; the work you came to residency to do.
Our upcoming book reframes planning as “setting up your future practice” instead of “homework”.
Our upcoming book reframes planning as “setting up your future practice” instead of “homework”.
February 2, 2026 at 2:43 PM
Many residents look at pre-op planning as “scut work”. It’s not, but it’s extra work for sure; the work you came to residency to do.
Our upcoming book reframes planning as “setting up your future practice” instead of “homework”.
Our upcoming book reframes planning as “setting up your future practice” instead of “homework”.
Permit me to besiege your morning to inundate you with my irrepressible inclination to deluge your dawnward attention with the ceremonious recognitions that accompany the sun's ascension.
February 2, 2026 at 1:42 PM
Permit me to besiege your morning to inundate you with my irrepressible inclination to deluge your dawnward attention with the ceremonious recognitions that accompany the sun's ascension.
Permit me to besiege your morning to inundate you with my irrepressible inclination to deluge your dawnward attention with the ceremonious recognitions that accompany the sun's ascension.
February 2, 2026 at 1:41 PM
Permit me to besiege your morning to inundate you with my irrepressible inclination to deluge your dawnward attention with the ceremonious recognitions that accompany the sun's ascension.
They are raking in pure free cash and collecting on both ends and exploit mostly scientists who just want to share something neat.
February 1, 2026 at 3:25 PM
They are raking in pure free cash and collecting on both ends and exploit mostly scientists who just want to share something neat.
Standardize by removing friction from execution. Make the correct action easy to perform, keep the decision to perform it deliberate.
Make the right action easy to execute and hard to ignore.
Reduce friction where discipline is wasted, preserve it where judgment matters.
Make the right action easy to execute and hard to ignore.
Reduce friction where discipline is wasted, preserve it where judgment matters.
January 31, 2026 at 4:38 PM
Standardize by removing friction from execution. Make the correct action easy to perform, keep the decision to perform it deliberate.
Make the right action easy to execute and hard to ignore.
Reduce friction where discipline is wasted, preserve it where judgment matters.
Make the right action easy to execute and hard to ignore.
Reduce friction where discipline is wasted, preserve it where judgment matters.
As a dad, I never leave home without my emotional-support ball-o-cords.
January 27, 2026 at 6:11 PM
As a dad, I never leave home without my emotional-support ball-o-cords.
“Parking now”
- db, 2026, AI - oil on canvas
- db, 2026, AI - oil on canvas
January 27, 2026 at 3:24 PM
“Parking now”
- db, 2026, AI - oil on canvas
- db, 2026, AI - oil on canvas
Permit acceptance conveyed with measured civility upon dawn’s arrival and receive my restrained recognition. Be assured; such acknowledgement is offered in composed fashion at outset. May this courtesy reach your attention as first observance preceding activity.
January 27, 2026 at 1:13 PM
Permit acceptance conveyed with measured civility upon dawn’s arrival and receive my restrained recognition. Be assured; such acknowledgement is offered in composed fashion at outset. May this courtesy reach your attention as first observance preceding activity.
The evening hours have besieged my attenuated, desiccated antiquity with their somnolent gravities, rendering my corporeal vessel an unwitting supplicant to the draping of said mortal architecture in heavy languors that foreshadow the dissolution of consciousness.
January 27, 2026 at 4:46 AM
The evening hours have besieged my attenuated, desiccated antiquity with their somnolent gravities, rendering my corporeal vessel an unwitting supplicant to the draping of said mortal architecture in heavy languors that foreshadow the dissolution of consciousness.
… And now I wish to slink back to the fethered ossuary from whence I disgorged.
January 26, 2026 at 5:57 PM
… And now I wish to slink back to the fethered ossuary from whence I disgorged.
You may have a hard time paying 50$ for a single 12 page article.
Instead pay 25$ for a 400 page hardcover book written by the same people who write those $50 articles, published at cost. Usually textbooks this size are over $400.
This isn’t an ad. I will send you the PDF if it is still too much.
Instead pay 25$ for a 400 page hardcover book written by the same people who write those $50 articles, published at cost. Usually textbooks this size are over $400.
This isn’t an ad. I will send you the PDF if it is still too much.
January 26, 2026 at 2:15 PM
You may have a hard time paying 50$ for a single 12 page article.
Instead pay 25$ for a 400 page hardcover book written by the same people who write those $50 articles, published at cost. Usually textbooks this size are over $400.
This isn’t an ad. I will send you the PDF if it is still too much.
Instead pay 25$ for a 400 page hardcover book written by the same people who write those $50 articles, published at cost. Usually textbooks this size are over $400.
This isn’t an ad. I will send you the PDF if it is still too much.
The crepuscular hemisphere, its umbrage encroaching, having dislodged this inutile frame from contemplative station unto recumbent necessity, compels a temporary dissolution of sentience.
January 26, 2026 at 2:00 AM
The crepuscular hemisphere, its umbrage encroaching, having dislodged this inutile frame from contemplative station unto recumbent necessity, compels a temporary dissolution of sentience.
AIS PSF TXA 5RCT n475 (Hi184 Lo144 ctl147; age15.1y; fuse10.4). EBL mL: Hi787 Lo705 ctl1016; Hi-Lo MD-98 (CI -647,426). vs ctl: Hi-319 Lo-219 (NS; P ctl worst=81%). Transf: placebo PRBC 6/55(11%) vs0/56. AE: 0 TXA vs1 bleed ctl(0.7%). Prac: Lo ok; Hi only if max bleed risk.
![Introduction Posterior spinal fusion (PSF) for adolescent idiopathic scoliosis entails notable bleeding and transfusion risk. yet optimal tranexamic acid dosing remains undefined. We conducted a network meta-analysis (NMA) comparing high dose. low dose, and no-TXA regimens in this setting.
Methods We conducted a PROSPERO-registered NMA (CRD420251033929) of RCTs in AIS patients undergoing PSF.
PubMed. CINAHL, EMBASE, reference lists, and grey literature were searched for trials comparing high dose (20-50 mg/ kg load; 10-20 mg/kg/h infusion), low dose (10 mg/kg load; 1 mg/kg/h infusion), or no TXA. Outcomes were pooled using a random-effects model to produce mean differences for continuous data and relative risks for binary data.
Results Five RCTs (n=475) were included. Patients had a frequency-weighted average (FWA) (SD) age of 15.1 (1.5) years. preoperative Cobb angle of 58.0 (7.9)°. 10.4 (1.3) levels fused, and operative time of 186.9 (62.0) minutes. They were
allocated to high-dose TXA (n = 184), low-dose TXA (n = 144), or no-TXA (n = 147) arms. The FWA total EBL was 787.3|
(261.5) ml. in the high-dose group, 705.3 (219.0) ml. in the low-dose group, and 1016.3 (492.2) ml. in controls. There was no significant difference in EBL. berween high- vs low-dose TXA (MD -98.3 ml. |-646.9, 426.2]). In the NMA, high-dose TXA reduced total EBL by 319 mL. (95% C1 -818 to 133) and low-dose by 219 ml. (95% C1 - 764 to 294) versus no TXA—an 81% probability that no TXA was worst strategy—though neither comparison reached statistical significance. When compared per fused level, High- and low-dose TXA reduced EBL. per level by 38.2 ml. (MD -38.2 |-86.3, d.I]) and 29.5 ml. (MD
-29.5 (-85.2, 27.3D) versus no TXA, respectively, without statistical significance; bowever, the no-TXA arm had an 87%
probability of being worst for EBL. by level. The FWA EBL. per level was 78.9 = 6.3 ml., 78.2 + 7.2 mlL., and 116.3+ 17.8 ml.
for high-dose, low-dose, and no-TXA groups (very low certainty). Wh…](https://cdn.bsky.app/img/feed_thumbnail/plain/did:plc:f4no6nzyhlzqpxju6a6awtic/bafkreicp54xp5tczqd2h6jgmzag7rdafm56yqv62fyd3i2crrpucbdptei@jpeg)
January 25, 2026 at 2:21 AM
AIS PSF TXA 5RCT n475 (Hi184 Lo144 ctl147; age15.1y; fuse10.4). EBL mL: Hi787 Lo705 ctl1016; Hi-Lo MD-98 (CI -647,426). vs ctl: Hi-319 Lo-219 (NS; P ctl worst=81%). Transf: placebo PRBC 6/55(11%) vs0/56. AE: 0 TXA vs1 bleed ctl(0.7%). Prac: Lo ok; Hi only if max bleed risk.