Podiatrists in Georgia can do hip, knee, and hand surgery???

[MacGyver]

Rumor thru the grapevine I heard that DPMs in Georgia are allowed by state law to hip/knee replacements as well as hand surgery.

Is this legit?

How the hell did you guys let this slip thru the cracks?

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[PediBoneDoc]

the laws vary from state to state ... i will refer you to an article from the attorney's point of view ... my feeling that most podiatrists should stick to foot and ankle because their training is spotty at best for anything above the distal tibia

http://www.footlaw.com/news/article.htm

hope this helps

 

[IlizaRob]

Rumor thru the grapevine I heard that DPMs in Georgia are allowed by state law to hip/knee replacements as well as hand surgery.

Is this legit?

How the hell did you guys let this slip thru the cracks?

This is absolutely not true. You need to check your sources, or maybe just look it up yourself. Some states allow DPMs to work with soft tissue to the knee and rarely the hip. DPMs should not be doing any bone work above the mid-shaft tibia at best. Anything above the tibial tuberosity is completely out of scope in any state. The majority of states restrict DPMs to below the distal 3rd of the tibia, although some laws are vague. There are also few states such as NY who do not allow DPMs even in the ankle.

 

[Debridement]

Rumor thru the grapevine I heard that DPMs in Georgia are allowed by state law to hip/knee replacements as well as hand surgery.

Is this legit?

How the hell did you guys let this slip thru the cracks?

The day that a podiatrist does a THR in my hospital is the day that a hooker does a penile pump implant.

Stop posting dumb shizzle,

DB back to the ED

 

[Dr_Feelgood]

The day that a podiatrist does a THR in my hospital is the day that a hooker does a penile pump implant.

I'm not sure about this analogue; I think that it is way off base. I'm not advocating that a pod do a THR nor would I ever want to do one. But the level of disgust that is implied is not appropriate.

As for Georgia the scope is soft tissue to the hip and osseous to the knee. No pod should be doing anything unless they have training in that area. I would not want a thoracic surgery to do a total knee or hip either. It is about training/experience not the letters behind the name that dictates were a person is able to perform a procedure.

The only things that I like about Georgia is 1) the can perform BKA, which I feel pods should be trained in. If most pods are working on limb salvage cases in DM patients they should be able to offer a BKA as a final resort. 2) in ankle fractures a Maisonneuve fracture should be able to be fixate by a pod.

I would never want to do anything in the knee or hip. That is ortho forever and always.

 

[Bull's eye]

I'm not sure about this analogue; I think that it is way off base. I'm not advocating that a pod do a THR nor would I ever want to do one. But the level of disgust that is implied is not appropriate.

As for Georgia the scope is soft tissue to the hip and osseous to the knee. No pod should be doing anything unless they have training in that area. I would not want a thoracic surgery to do a total knee or hip either. It is about training/experience not the letters behind the name that dictates were a person is able to perform a procedure.

The only things that I like about Georgia is 1) the can perform BKA, which I feel pods should be trained in. If most pods are working on limb salvage cases in DM patients they should be able to offer a BKA as a final resort. 2) in ankle fractures a Maisonneuve fracture should be able to be fixate by a pod.

I would never want to do anything in the knee or hip. That is ortho forever and always.

If you can do ankle fractures with a syndesmotic screw then you can fix maisonneuve fractures. It doesn't need any other fixation.

 

[Dr_Feelgood]

If you can do ankle fractures with a syndesmotic screw then you can fix maisonneuve fractures. It doesn't need any other fixation.

I learned something today.

How about this one, if they have soft tissue to the hip they can harvest their own skin grafts for use in non-healing wounds.

 

[dawg44]

I think skin grafts are overrated for chronic wounds anyway. The VAC is king if the bloodflow is good.

 

[Dr_Feelgood]

I think skin grafts are overrated for chronic wounds anyway. The VAC is king if the bloodflow is good.

I don't know about this. We were part of the VAC study at DMU and you can't deny the ability of the system to get a great granular base. BUT, the closure time was no better than wet to drys. From my understanding (according to the reps and the researchers at the CLEAR lab in Chicago), the VAC should be used to get a great base, then a skin graft or a graft substitute (Dermograft, Allograft, or anything else they made out of that guys fetal foreskin) should be place on with the VAC system.

The VAC is definitely one area that I do have experience with.

 

[SOUNDMAN]

I think skin grafts are overrated for chronic wounds anyway. The VAC is king if the bloodflow is good.

VAC's > all, I've seen some amazing wounds heal with that wonderful machine. The thing I love with the VAC is if you have a deeper wound or large wound, it seems from my experience to really pull that granulation tissue up and together. I've had some "tunneling" type wounds from surgeries and surgical site infections that the VAC has worked miracles with as well. As for actual studies comparing wet/dry with the VAC, I don't have that knowledge. However for large wounds, I've seen some cool healing with the VAC.

 

[dawg44]

We never had to use a skin graft, dermograft etc in my fellowship for a chronic wound. That's my experience why I think they are overrated for use in chronic wounds. Ancedotal I know, but it is what it is for me. I know the companies make alot of jack off of them and have lots of fancy pictures. I used skin grafts all of the time for closure of trauma wounds, fasciotomy sites, etc but like I said never for a chronic one.

 

[Dr_Feelgood]

We never had to use a skin graft, dermograft etc in my fellowship for a chronic wound. That's my experience why I think they are overrated for use in chronic wounds. Ancedotal I know, but it is what it is for me. I know the companies make alot of jack off of them and have lots of fancy pictures. I used skin grafts all of the time for closure of trauma wounds, fasciotomy sites, etc but like I said never for a chronic one.

I completely understand what you are saying. But a very famous doctor would give you crap b/c he says their is no such thing as a chronic wound. If it comes into your office and looks fibrotic and chronic, you debride the heck out of it and make it an acute wound. There are non-healing wounds not chronic wounds.

I have seen a lot of things fail on non-healing wounds. Heck most grafts, ect. just slough off. The most effective thing I have every seen for non-healing wounds is a total contact cast. It beats the VAC everyday and twice on Sunday. It would be interesting to see the VAC used in a total contact system. We have a patient in a similar set up right now but he is about as compliant as a wolverine. He walked out of an ex-fix and a STJ/talotibular joint fusion rod. The rod was almost all the way out of his calcaneus.

 

[dawg44]

I completely understand what you are saying. But a very famous doctor would give you crap b/c he says their is no such thing as a chronic wound. If it comes into your office and looks fibrotic and chronic, you debride the heck out of it and make it an acute wound. There are non-healing wounds not chronic wounds.

I have seen a lot of things fail on non-healing wounds. Heck most grafts, ect. just slough off. The most effective thing I have every seen for non-healing wounds is a total contact cast. It bets the VAC everyday and twice on Sunday. It would be interesting to see the VAC used in a total contact system. We have a patient in a similar set up right now but he is about as compliant as a wolverine. He walked out of an ex-fix and a STJ/talotibular joint fusion rod. The rod was almost all the way out of his calcaneus.

I bet you meant beat and I'm glad you mentioned it. I agree total contact casts are completely underused today. You know how you fix them from walking on an ex-fix? Make one of the rods too long so it sticks about 3-4 inches below the foot, so unless they are an acrobat and can balance on the end of stick they can't walk on it.

 

[jonwill]

I bet you meant beat and I'm glad you mentioned it. I agree total contact casts are completely underused today. You know how you fix them from walking on an ex-fix? Make one of the rods too long so it sticks about 3-4 inches below the foot, so unless they are an acrobat and can balance on the end of stick they can't walk on it.

That's a pretty good idea. I'll have to try it.

 

[Dr_Feelgood]

I bet you meant beat and I'm glad you mentioned it. I agree total contact casts are completely underused today. You know how you fix them from walking on an ex-fix? Make one of the rods too long so it sticks about 3-4 inches below the foot, so unless they are an acrobat and can balance on the end of stick they can't walk on it.

I like that and yes I meant beat. I guess with all of this March Madness, I have bets on my mind.

 

[IlizaRob]

I completely understand what you are saying. But a very famous doctor would give you crap b/c he says their is no such thing as a chronic wound. If it comes into your office and looks fibrotic and chronic, you debride the heck out of it and make it an acute wound. There are non-healing wounds not chronic wounds.

I have seen a lot of things fail on non-healing wounds. Heck most grafts, ect. just slough off. The most effective thing I have every seen for non-healing wounds is a total contact cast. It beats the VAC everyday and twice on Sunday. It would be interesting to see the VAC used in a total contact system. We have a patient in a similar set up right now but he is about as compliant as a wolverine. He walked out of an ex-fix and a STJ/talotibular joint fusion rod. The rod was almost all the way out of his calcaneus.

I was seeing this patient for a while and had the chance to scrub in on a few of his surgeries. Talk about the king of non-compliance. He snapped a pin from an ex fix rail in half and claimed he never walked on it. I like Dawgs idea about the IM nail, but I dont know, this guy will do anything.

 

[dawg44]

I've used it many a time. Most of the time they complain that they can't walk on it. I say exactly and leave the room.

 

[Dr_Feelgood]

I say exactly and leave the room.