Clinical decision support that reasons like an orthopedic surgeon: run the open-fracture clock, tap the hot joint before you treat, time the joint replacement by symptoms not films, and catch compartment syndrome early — with the decision rule and exactly what would change it. Built for verified physicians.
Two real orthopedics questions, each reasoned the way HeyHippocrates answers: the skills fire, the answer is cited, the decision rule is explicit, and what's missing is flagged. Scroll to each.
A tibial fracture with bone through the skin after a motorcycle crash — the first hour?
Treat the open fracture as a time-critical emergency. Give intravenous antibiotics as soon as possible — within the hour — because time to antibiotics is the strongest modifiable predictor of infection; cefazolin covers most, with added gram-negative or anaerobic cover for higher Gustilo grades. Update tetanus, remove gross contamination, cover the wound with a saline-soaked dressing, and splint. Then take the patient to the operating room for formal irrigation and debridement and fracture stabilization.
Decision ruleOpen fracture → IV antibiotics within 1 h (cefazolin, escalate by Gustilo grade); tetanus; gross decontamination + saline dressing + splint; urgent irrigation and debridement in the OR; then stabilize the fracture.
Not established from this alone — the Gustilo grade, the contamination and the soft-tissue injury change the antibiotics and the timing.
An acutely swollen, hot, painful knee that cannot bear weight, with fever — the essential step?
Aspirate the joint before starting antibiotics — synovial fluid analysis is the decisive test. A white-cell count above roughly 50,000 with neutrophil predominance, or a positive Gram stain or culture, points to septic arthritis, and the presence of crystals does not exclude infection. Septic arthritis is a surgical emergency needing urgent washout, arthroscopic or open, plus intravenous antibiotics; a purely crystal arthritis is treated medically. When in doubt, treat as septic.
Decision ruleArthrocentesis before antibiotics; synovial WBC over ~50,000 + neutrophils, or positive Gram or culture → septic arthritis (crystals do not exclude it); urgent washout + IV antibiotics; crystal-only → medical therapy.
Not established from this alone — the synovial analysis, the cultures and the host change the diagnosis.
Illustrative simulations. The physician always decides.
The exact questions your field searches for — answered in the format the knowledge base speaks: the answer, the decision rule, what's missing, and the source.
Give intravenous antibiotics as soon as possible — within an hour — because time to antibiotics is the strongest modifiable predictor of infection; cefazolin covers most, with added gram-negative or anaerobic cover for higher Gustilo grades. Update tetanus, remove gross contamination, photograph and cover the wound with a saline-soaked dressing, and splint. Take the patient to the operating room for formal irrigation and debridement, then stabilize the fracture.AAOS · open fracture
Decision ruleOpen fracture → IV antibiotics within 1 h (cefazolin, escalate by Gustilo grade); tetanus; gross decontamination + sterile dressing + splint; urgent irrigation and debridement; then fracture stabilization.
Missing data: the Gustilo grade, the contamination and the soft-tissue injury change the antibiotics and the timing.
Aspirate the joint before starting antibiotics — synovial fluid analysis is the decisive test. A white-cell count above roughly 50,000 with neutrophil predominance, a positive Gram stain or a positive culture points to septic arthritis, and the presence of crystals does not exclude infection. Septic arthritis is an emergency needing urgent surgical or arthroscopic washout and intravenous antibiotics; a purely crystal arthritis is treated medically. When in doubt, treat as septic.AAOS · infection
Decision ruleArthrocentesis before antibiotics; synovial WBC over ~50,000 + neutrophils / positive Gram or culture → septic arthritis (crystals do not exclude); urgent washout + IV antibiotics; crystal-only → medical therapy.
Missing data: the synovial analysis, the cultures and the host change the diagnosis.
Start with the evidence-based nonoperative ladder: education and weight loss, a structured exercise and physiotherapy program, and analgesia — topical or oral NSAIDs, with an intra-articular corticosteroid for a flare. Reserve total joint arthroplasty for end-stage, radiographically confirmed osteoarthritis with pain and functional loss that persist despite adequate nonoperative treatment, not for imaging findings alone. Match the timing to the symptom burden, the failure of conservative care and the patient goals.AAOS · osteoarthritis
Decision ruleOsteoarthritis → nonoperative first (weight loss, exercise/physio, topical/oral NSAIDs, intra-articular steroid for flares); total joint arthroplasty for end-stage radiographic OA with persistent pain and functional loss despite conservative care — symptoms, not imaging alone, drive timing.
Missing data: the symptom burden, the radiographs and the response to conservative care change the timing.
Suspect acute compartment syndrome after a fracture, crush or reperfusion when pain is out of proportion and worsens on passive stretch — the earliest and most reliable sign — with a tense compartment; paresthesia, pallor, pulselessness and paralysis are late and unreliable. Remove circumferential casts and dressings, and if the diagnosis is clinical or the compartment pressure is within about 30 mmHg of the diastolic, perform an emergency fasciotomy. Delay causes irreversible muscle and nerve loss.AAOS · trauma
Decision rulePain out of proportion + pain on passive stretch + tense compartment → acute compartment syndrome (late Ps unreliable); release casts and dressings; emergency fasciotomy if clinical or delta pressure under ~30 mmHg; do not wait.
Missing data: the exam trend, the compartment pressures and the mechanism change the urgency.
Your whole practice, one specialist brain — grounded in champion-authored, cited knowledge.
A generalist orthopedics colleague across trauma and fractures, the hot joint, limb emergencies, degenerative disease, bone health and hand and foot — cited, non-directive, always with the decision rule.
Deep specialist agents for orthopedic trauma, adult reconstruction, sports and arthroscopy, and hand surgery — each its own soul and knowledge base — plus your own uploaded materials.
From the antibiotic clock to the joint tap the margin is thin. Only one of these reasons like an orthopedics colleague whose every claim you can trace.
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It reasons in the frameworks you use — the open-fracture and Gustilo pathway, the arthrocentesis rule for the hot joint, the osteoarthritis ladder and the compartment-syndrome signs — and always shows the reasoning, the decision rule and what would change it. The decision always stays your call.
Both. Residents use it to pressure-test a plan and learn the decision rule; attendings use it as a fast, cited second opinion on trauma call and in clinic. Access is gated to verified physicians.
Trauma, adult reconstruction, sports and arthroscopy, and hand surgery each have their own deep specialist agent on the Pro plan, on top of the full orthopedics scope on Basic.
No. It is physician-facing clinical decision support — a cited thinking partner. It does not diagnose, does not treat, and gives no patient-facing advice. The decision always stays with you.
Every answer is grounded only in champion-authored, cited orthopedics knowledge — traceable, not hallucinated — and always states the decision rule plus what data is missing, instead of a confident guess.
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