r/orthopaedics

Hey all, educational question :)

I'm a last year resident and, in my last shift, I had the patient with a painful calf at the level of Achilles after he mistakenly stepped during the walk. Few years ago, he had an Achilles rupture on the other leg and, comparing both, he said this injury was far less serious for him compared to the previous. Clinically, he had no hematoma, no palpable gap, Thompson was negative (i squeezed his calf like 5 times to be sure). He was barely limping. We do not usually spam ultrasounds for every suspicious tendon rupture at the hospital but I usually do them on my own just for the sake of educating myself. This time, having a busier ER than usual, I decided to skip it as it seemed to me unlikely that he had a rupture based on his history and physical exam.

Today, I found out he went to another hospital 12 hours lated and was diagnosed with the ruptured Achilles and positive Thompson. Now, I do not know if he had another injury in the meantime but I do not think so. Have you ever experienced that? Do you proceed with the imaging regardless of history and physical exam in these situations or you rely on clinical exam more? I know other calf muscles can compensate for the ruptured Achilles and have observed some of those but they were still looking far worse than this patient was.

Thanks all,

EDIT : I wrote he had a surgery first but it was misinformation from my department. I called my colleague who’s working at that hospital and it was a high rupture that will be treated conservatively. Still, I missed it.

hi guys i have. a pretty strong home program for ortho at a big public school but we are very blue-collar and not research heavy. they strongly recommend finding research elsewhere to bolster the network but elsewhere close to home for me means columbia, nyu, hss etc (aka places that are impossible) so i was wondering what are good places for an m1 to reach out for research in the nyc area that would likely take people from not in their program to help out on research

YOG: 2024

Experience: All clinical rotations in the US.

12 months in Head and Neck Oncology and Trauma in clinical role working alongside residents and attendings for preop and postoperative assessments. (2 strong LORs for Surgery).

13+ months: Licensed, Orthopedic Surgery First Assistant at high volume academic institution (top 5 in the country). Assisted in over 800 procedures across adult recon, hip preservation, oncology, trauma, spine foot and ankle, ENT, plastics. In this role I am actively part of patient care providing independent closure of capsule, adipose layer and skin. Position and prep patients and mentor students, help fellows start cases with attending’s preferences and approaches, support residents and teach interns basic arthroplasty principles and closure etc.

Weak scores (Step 1: 215, Step 2: 237, Step 3: 205)

Research: 1 first author (JAAOS publication), 2 submitted (2nd author), all with big academic institutions (don’t know if that matters).

Question: With this profile, can I do it? Obviously, I tried to match in my current institution but it didn’t work despite 2 strong letters from faculty. Connections got me the interview but My scores just shut that door together with no publication at the time and they have never taken a non-US applicant. I am not applying there this time nor to any academic institutions for Ortho.

Are there programs that I can apply to for ortho that can consider my app? Should I just focus gen surg, prelim? Or do something like Emergency Med?

Was recently offered by faculty to help with a book chapter. How are book chapters typically viewed in comparison to study publications for fellowship?

Hey Im looking to switch out of Synthes-Trauma. I literally dont know any next steps. If anyone can point me in the right direction. The on call schedule is getting to me, I would like to hear your story because Im the "new grad who was eager" now im realizing it is not what I thought it was going to be. Almost 2 years in and there hasn't been a steady month, im realizing there is always turnover and problems out of my control here.

Hi everyone ,
What are your tips for getting the guidewire to pass through distal segment in antegrade femoral nailing ? I find this part of the procedure the most challenging .

Looking for advice on what to do if I want to switch into ortho this late in the game (ERAS due in one month). What are my options? Should i seek out a research year or do a surgical prelim year? Is it even possible to get Sub Is at this point? Is it worth it this late in the game (ie. will i be burnt out from taking year off, applying, and not matching?)

See story below if interested

Was concerned about lifestyle at one point but i think it was more so fear of residency but now realize that every residency will be tough and actually met residents who were very happy ( i think i was just scared from reddit) Moreover, if you are passionate about something, time moves a lot quicker. Later reflected that even tho i was tired watching surgeries all day from the side, not doing anything while still waking up early, i felt fulfilled leaving and less burnt out then when i was on rotations looking at computer all day. I actually didnt mind having to be in the OR on the side watching and i think it was frustration from not getting to participate.

I am a hard worker and willing to take a year off but dont know where to start. Was originally planning on applying IM-sub spec but for some reason I miss being in the OR and all the pathology with regards to ortho. I love working with my hands and dont know that the IM sub spec will scratch the same itch.

I did 2 ortho electives during third year and thought i didnt like it but in reality i think i didnt like being a med student. Looking back its not that i didnt like the OR but i wanted to be involved and have responsibility as opposed to just watch in the corner. Arthroscopy on the screen can look boring but much different when you are actually doing it. Ortho and surgery (did it before my gen surg core) was new to me and i thought because it was foreign that i wouldnt be good at it but now that ive went through everything i dont feel as excited for something like IM. Even during my EM rotation, i loved doing the lac repair and did not find the same satisfaction from intubating, central lines etc.

My app: DO, I have one ortho related first author, bottom quartile preclincal but HP/Honor all rotations and hoping boards will make up with high score. Its a uphill battle...

Want to know if i am a lost cause or not. Is it worth to pursue a year off right before I apply? Cant get the feeling out of my head that applying IM doesnt feel right. I heavily considered peds sub specialties but felt like it was gonna go down that path that i would much rather do peds ortho.

tldr; one month till eras app, ortho giving me a gut feeling to pursue, hard worker but not strong app rn but willing to take year off if theres an opportunity/pathway; want to know if its possible (ie not taking >2 years to match)

How much does medical school prestige impact match into orthopedic surgery (if it does at all)?

In May, I went to Europe where I interviewed 14 international renowned complex knee surgeons, 12 of them have PhD’s. Learned a lot, 2 hour interview. These were not job interviews. I started this project January 2023 in Norway. I have interviewed surgeons in Vail, California, Minnesota and all over the US. I have have interviewed the biggest names in orthopedics.

Looking for the best international renowned orthopedic sports med surgeons to interview next in Canada? Please let me know. Complex Knee, Shoulder, Hip, Elbow, Hand/Wrist, Canadian Ski Team, Montreal, London, ON, Toranto, Calgary, etc. They do not need to be Canadian Ski Team.

I will start off:

Mark Heard, MD

Do patients ever judge you by your undergrad/med school? Like would a surgeon who went to Harvard for college through fellowship have more oppurtunity/volume than someone who went to their state school (for private practice not academia)?

What would your usual referral thresholds for a traumatic intramuscular quadriceps hematoma, particularly one involving the vastus intermedius.

Things I'm particularly curious about:

• Size or characteristics of the hematoma on ultrasound/MRI
• Degree of disability
• Failure to improve over a particular time period
• Concern for complications such as myositis ossificans, compartment syndrome, or an associated intra-articular injury
• Whether there is a particular time point after injury when lack of improvement would change your threshold for referral

tldr: What clinical features would make you refer an intramuscular vastus intermedius hematoma to orthopedics?

These are the only 2 specialties that exist. Which one is the more pragmatic choice? Why?

Thoughts? Im interested in joints and was wondering how much of an impact this will have

I am an M2 student. Recently decided to put all my efforts towards orthopedics.

I have been cold emailing a lot of surgeons at academic institutions but the common block I get from those that respond is that the institution will not grant EMR acess to remote students. The opportunity has to be in person which is not feasible due to my med school being a few states away.

I was thinking about attending a local conference to network and maybe see if that would be fruitful to some extent.

Hey all, I am a resident in Lithuania. I got someone with a case of what is essentially, reverse club foot. Rather than leg inwards, it's outward, in a varus-like manner. Patient is also a bit older too, no longer a kid.

Any idea how I might go about treating this without surgical options? For those who are medically trained around the world, please chime in. Interested to hear your thoughts, and whether you've experienced something similar.

I am pretty new to this profession still btw.

Ladies, gents

How do you prepare for surgeries as an attending?

I’m soon to be done with mine residency (non-US), and looking for a nice online sources.

I’m currently mostly using AO Surgery ref and youtube when doing my cases but would really appreciate any other recommendations , especially anatomy related? Heard bout KenHub but haven’t used it, is it good?

Seeking advice from those who know better than I do.

I’m a spine fellow and have been receiving some offers from private groups in a variety of major/mid major cities in the Midwest. Some physician owned & some PE backed. What are market comp standards I should expect and what are red flags? I have no idea what’s normal.

-what’s a normal non-partner salary
-normal partner salary/ expected comp?
-Best structure over all? (RVU based etc.)
-bonus structure? One group had “X% (which was low) of revenue minus ALL expenses” (this seemed bad)

Would really like to know what’s to be expected. Some offers make me feel taken advantage of. I’m not trying to make $2M and buy a Ferrari but truly need input from those who have fair packages.

Seeking any in all guidance. I don’t want to be a horror story. Just want to be competitive and set my family up for a successful future. Thanks.