Through physiotherapists? If through physiotherapist, is it through texting? How important is patient's progress post surgery for orthopedics?

I was thinking between orthopedic and plastic

May need to do locums for a few months to a year. How has everyone’s experience been with it?

This question pertains to the hypothetical limitations of tension band playing on the anterior side of the tibia, clinically relevant for anterior tibial fractures. Obviously not a personal question. I haven't had any surgeries (my previous post was removed).

If a patient has anterior tibial stress fracture, tension band plating is applied with four screws above and below the fracture area, is it wise to remove these following the surgery if the patient wishes? As anterior stress fractures are notorious for slow healing and the hardware is introduced to take off the tensile forces and allow the initial fracture to heal, is there not a risk of the holes from the screw having non-union?

Hello! I‘m soon leaving my institution for greener pastures (read: my manipulative boss tries to bully me into a position that is a guaranteed dead end, if suicide doesn’t take me before).

However, i have made good friends especially among my coresidents and i want to give them little gifts to remember me by. The less closer ones get a good bottle of wine, the closer ones get something more personal.

One senior resident wants to go into pediatric orthopedics, especially corrective surgeries. Lutz van Laers book is the pediatric ortho bible around here but very fracture oriented.

What would be your recommendations on literature that would give him something that will help him along the way?

Thanks!

Hi bros/broettes, I'm a PA that works for an adult recon specialist. We recently cancelled an elective THA in an 80 year old female because her PCP ordered pre-op u/a. Surprise, it had weakly positive leuk esterase and grew E. coli. She's completely asymptomatic. I didn't think it was a big deal but ran it by him anyway, he obviously did, cancelled the surgery, and let the PCP know, who sent patient to ED for IV abx (?)

Maybe I'm showing my lack of training here, but my understanding is... some older women just have lifelong asymptomatic bacturia, and treating is futile. From what I can find in JBJS and Uptodate that seems accurate, but my doc asked some of his buddies and they all agree she needs to get treated.

Any words of wisdom?

Btw, in the ED, u/a was negative and consulted ID discharged her without treatment.

Little over 1 year out from beginning my sub-i's.

What do you expect med students to know when they start their rotation? Things that I should be learning over the course of the year to put my best foot forward? Any textbooks/reousces that I can buy to learn from?

Thanks for taking the time to read

I’m having trouble understanding when a screw through a nail is in dynamic vs static mode when put through an oblong hole. Is it different for femur vs tibia?

For example, in my mind for a long femoral nail to be in dynamic mode, you would need to put the distal screw in the proximal portion of the oblong hole. This allows the bone to move distal (and nail to move proximal) providing fx compression.

For a tibia it’s reversed though? In a tibial nail for compression mode you would need to put the screw in the distal portion of the oblong hole. Allowing bone to move proximal (and nail to move distal).

Is my thinking correct? And if so, is this just because of how the femur vs tibia both react when weight bearing? Femur bone moves distally due to the weight, while tibia moves proximal?

Appreciate any insight and clarifications. Shouldn’t be hard, but I like to overthink. Thank you

Would you be willing to share your salary anonymously if it unlocked the salary of your peers?

There are a few different threads here on salaries but the data is too unstructured and it does not have the full context. Compensation is about the full package - including shifts, schedule, PTO, benefits, etc. and not just the basic median pay you get from sources like MGMA, Medscape, etc. It's all so opaque and simply too expensive for us to get as individuals.

A few months ago, friend of mine, who's an anesthesiologist, created a structured questionnaire and a google sheet and crowdsourced 450+ anonymous salaries from anesthesiologists. It was a rudimentary sheet, but it seemed to work really work. I have since worked with him to make a few improvements to the sheet to collect data for more professions (MDs, APPs) and specialties in a spreadsheet. We have made some good progress across a few different specialties, and would be great to get some ortho specific data as well. This is fully anonymous, so it really decreases the taboo of discussing our comp.

Check out the sheet below (it's organized by groups of specialities - to keep it manageable), and if you are willing - please add yours too. Once you share your salary details, it will unlock the full spreadsheet of all the salary contributions so far. The more data we get in there, the more useful it will be for all of us! And if you have any feedback on how we could make it better, please DM me.

https://docs.google.com/spreadsheets/d/1yuHo2iHvrKayUYii4N01h4VtVh2Qmo40qCQ6qu1-CoA/edit?usp=sharing

I am a current PGY3 and I am torn between applying to sports or trauma fellowship next year.

Sports: The lifestyle is attractive, but I don't get super excited about arthroscopy. I don't dislike scopes but I dont get excited about them in the way I do about fracture cases. RTC repair and ALCs aren't bad and can be kinda fun sometimes, but I could see myself getting bored. It seems like a lot of community sports guys still do a lot of trauma and total shoulders and knees, which is what I would want to do if I do go into sports, but it seems a little silly doing a sports fellowship if I still just want to do a lot of trauma and some joints. It also seems like sports tends to be more clinic heavy and you need to see a ton of patients in clinic to get the operative volume, and I hate clinic. The lifestyle is definitely attractive though, especially as I get older and have a family when having work be a little more routine and flexible might be a good thing if it means more time with family.

Pros: Lifestyle, flexibility

Cons: Dont love scopes, lots of clinic

Trauma: I love fracture cases and get more excited about them than sports cases. I like the variability, the challenge of figuring out how to fix a fracture and operating all over the body. The lifestyle of trauma scares me though, although I have only been exposed to trauma at extremely busy academic trauma centers. What does trauma look like in a private or community setting?

Pros: Fun cases, interesting, challenging, less clinic

Cons: Lifestyle, less flexible, more academic (and I probably don't want to practice in academic setting)

Overall, I enjoy trauma more, but the lifestyle factor is making me lean more towards sports. Does anyone have some insight on what the trauma lifestyle looks like outside of busy level 1 academic centers? I don't mind having a late night in the OR every now and then, especially if the clinic days tend to be lighter, but operating until midnight 3 nights a week when I have a family at home is not something I have any interest in doing. That being said I think I would be happy doing maybe 1 OR day of bread and butter sports, and 1 OR day of trauma. How feasible would this be as a community/private practice sports guy? My program has excellent trauma experience so either way Ill be comfortable doing just about anything besides pelvis and blasted periarticular work by the time i graduate.

I would appreciate if anyone has any insight or advice, thanks!

Is there a way to obtain the dimensions of existing one-piece silicone implants for mcp joint?
This is crucial for my M. Tech project, because I have to replicate the CAD models of these implants for a comparative study. I have tried searching many research papers and also browsed the internet, but ended up getting the overall dimensions only.

TLDR: What do you look for in a good radiology group reading your scans?

Bit of an unusual question for this group but I was hoping to get some insight from your perspective.

I am a musculoskeletal radiologist. There is a shortage of radiologists in the country (USA) and many radiology groups are demanding higher reimbursement rates from hospitals and referring docs to read their scans. If it hasn’t happened to your group yet, it will probably be coming soon.

I was considering starting my own teleradiology group specializing in outpatient orthopaedic imaging. I think we could be more competitive on price and more nimble than large multi-specialty radiology practices that are trying to hire multiple different specialties, cover hospital call, etc.

For those of you that own their own MRI’s and sign read contracts with radiology groups - what do you find really important in a group you contract with?

-Price per scan? -Fast turnaround time? -Ability to communicate with the group about your needs/issues that arise? -Ability to easily communicate with the reading radiologist? -Ability to request certain rads do read or don’t read your scans? -Any other major issues that you can think of?

Medical student on auditions here. It’s now been twice (edit: on different auditions) that I’ve been specifically asked who wrote the paper on tip-apex distance, when it was published, and what construct was examined. What are some other classically pimpable papers I should know as a med student?

Being trauma trained, I see a fair number of other surgeons' complications related to poorly done fracture work. One classic example is a periprosthetic femur fracture referred to my office that failed 2 months after initial fixation. The reduction during the first procedure was in clear varus and the lateral plate was much too short and the patient is now asking why the plate broke so soon. However, I have some trouble delicately explaining to patients why their first surgery failed without throwing the other surgeon under the bus. Any thoughts?

First time I see something like this. 74 male, his Xray was sent to me, complaining of shoulder pain after farming.

What lead glasses do you guys recommend? I had the Oakley holbrooks and the lens just popped out and shattered on the ground

For instances, Tectus from Blatchfordmobility. It can be something else.

I just need to know average cost?

It gives painless mobility to people who have paralisis due to something like chronic achilles tendon injuries/ just pain due to some accident.

What do the hand surgeons here think of this new nejm article: https://www.nejm.org/doi/full/10.1056/NEJMoa2312631

Hi all

I have been reading on the legislative change in several US states allowing for provisional license to practice for foreign trained doctors and was wondering how likely it is for an orthopedic surgeon from abroad to actually get a provisional license?

There are certain hurdles such as USMLE, ECFMG and OET that generally need to be fulfilled which is on the doctor applying for it, but then comes getting a position at ACGME approved location which is outside their influence. How likely is that?

As I understand the changes come in order to combat the lack of doctors in underserved areas and currently the residency programs can't fulfill the need for doctors.

Would love to hear people's thoughts on this actually having any impact for doctors in general as well as orthopedics specifically

Hello,

I'm in my senior capstone course, and my team and I are interested in understanding orthopedic surgeons' experience with handheld surgical instruments. We would greatly appreciate any insight that you could provide us.

Have you experienced wrist pain/discomfort due to any of these factors?

Thank you so much!

​

View Poll

Hey yall,

Currently thinking about doing a gap year for ortho research but wondering how difficult it is to get into these research year programs. Ik it most likely varies from institution to institution but if I were looking into the fellowships at Hopkins or NYU, for example, should I be applying to a bunch of them and hope my app gets traction? Or is it not so hard to get into one of the established ortho research gap year programs?

I would like to know your opinion or experiences with surgeons with Asthma.

Thanks for taking the time to read it.

So a 42yo patient came to my consultory for knee pain. He had pain only at medial comparment, not at patella, not at lateral compartment. MCL, cruciate ligaments with no injury judging with the physical check. I took plain x rays and a weight bearing pelvis to foot x rays (In Spain it's called a "telemetria") and I saw a 14 degree mechanical varus, with ldfa = 95°, and sligh knee medial osteoartritis. Knee injections of steroids or visco didn't work. That's why I gave the patient the option of making double osteotomy taking Fujisawa reference of 16°. I thought about lateral closing wedge of distal femur of 6° + medial opening wedge osteotomy of proximal tibia of 10° + hidroxiapatite bone substitute, using plates (not staples).

1 month later, closing wedge osteotomy looked completely healthy and scar was fine. Opening wedge looked fine at x rays but wound started draining not purulent liquid. I made a debridement without removing the plate, took samples for microbiology and started antibiotics (3w endovenous and 6w oral)

He is now at his last week of oral antibiotics. But wound gave problems a month ago for a second time, because skin tension over the plate made skin suffer and finally appeared a lack of skin over the plate, 1cm diametre. Plate has never been visible. I have applied negative pression wound therapy for a month but don't work properly.

Today I have run a CT on the tibia, where it seems hidroxiapatite is still not integrated to the bone. Blood test with 6000WB and CRP 5.

What would you do?

Friedrich wound surgery? Second debridement? Plate removal to see if opening wedge is healed? This last option make me think about external fixation just in case.

Please, any idea is welcomed.

I can send x rays and CT images via DM is you are interested.

Throwaway for anonymity

TLDR: Would you stay in private practice if you were W2 with no likelihood of becoming a partner and didn’t have ASC ancillary income?

Private practice, 100% eat what you kill. Joints trained. A few different choices led to this, but I’m in an employed position after some changes within our group. Gave up trying to feed the greed to become a partner in the group’s ASC years ago. Lots of outpatient cases, they just leave from the hospital. Fine with me, I get paid the same.

I feel like I could put up with a lot of BS from hospital admins for the amounts of money that hospital employed docs are likely making. I’m comfortable, 500+ before taxes, but hard to stomach paying overhead when that’s the end number, given production. North of 12k wrvu.

There’s probably more but I suppose that’ll prime the pump.

Hey all, MS3 stressing about what to do in my situation. I've been grinding research since M1 but some of my projects are in limbo, and I'm not sure if they'll be published by next september. Have also had a rough start to grades 3rd year, so I've been considering taking a year for research + building connections. Most likely not going to get AOA.

Background: US MD

Step 1 P

Clerkships: H surgery, HP neuro, P OB :(

Research: 2 non-ortho pubs (1st author). 2 first author ortho papers should hopefully be submitted in the next few months. 2 other 1st author ortho papers in progress. ≥15 abstracts/posters, including podium pres at natl meeting.

Other projects ongoing, but in conception phase so unlikely to get much out of them by next year.

Obviously need to get as many H's as I can this year and kill step 2, but would a research year make sense for me? School advisors have told me not to apply if I dont have at least 5 Pubmed indexed papers. Ortho mentors have told me they recommend all students do one if they have the time. I'm a nontrad so I'd prefer not to, but I'm open to it if it can help me match and make up for my middling grades.

All thoughts and advice are greatly appreciated. Would love to hear from people who have taken a RY and how their experiences were as well.