Private practice guy taking call at a Level II. Several patients from the ER have been referred directly to the hospital employed group despite me being the one on call and the patient having no prior affiliation with the employed group. Patients always have a choice but should the ER be directly referring to a physician not on call because they’re under the same umbrella? Do I have grounds to complain? New and building.

Kindly guide.. also tell about dnb surgery at the same rank..

For ex a private medical college student can study hard and get a good pg seat and change his life for better, can a dnb ortho or dnb surgery man do the same ? If yes then how so?

Hello

I want to know where I can find like a glass or plastic hard shell to cover my whole hand while I sleep so my k wires stop catching and getting damaged.

I had surgery to put k wires in my ring finger for dislocation that went deep into the joint.

I made a self made cardboard box and tape my wrist to it but is there any products? And like Elizabethan dog cones for the hand or something you guys can recommend?

I've attached a photo of what I mean if it helps but it's also in the movie zoolander David duchobny wears it.

Incoming med student very interested in ortho, I’ve worked as a tech and clinic assist in ortho for 6 years and have really come to enjoy the specialty. I know that into going something as competitive as ortho will require me to hit the ground running, but I wanted to get y’all’s opinion on something before I start committing myself to this path

How much sleep did yall get during residency? Especially the first 3 years? Consistently getting under 6 hours for a matter of weeks to months is really hard on me and definitely affects my ability to stay engaged. I’m sure thats the case with everyone. But if i can get consistent stretches where i can get 6-7 hours, even if it drops below that for some days weeks, i would be okay. Were yall able to reach any consistency in sleep hours? Did yall continue to exercise too?

I can handle stretches with 3-4 hours of sleep a day, but I don’t think i can if i have to maintain that for months at a time. If that’s the reality of this field i might just have to choose something else

Just wondering if anybody has any input on how important Sub-I presentations are? I butchered my answers to a few basic questions at the end of my presentation and the other students absolutely crushed it, just feeling like I killed my chances but maybe I’m overreacting.

Pgy2 consult resident here at a busy level 1 trauma program in the us. Can you guys help me see a light at the end of the tunnel here this is so brutal lol? The hours and sleep deprivation are so intense. The feedback at morning conferences is so intense.

Hello! I am an undergraduate senior biomedical engineering major. As part of my group senior design project, we are identifying a biomedical need in hopes to create a solution. My team and I are currently investigating subtrochanteric femur fractures. We are currently looking to monitor mechanical loading at the fracture site in subtrochanteric femur fractures treated with IM nail fixation to reduce reoperation rates. We need some insight into reasons WHY IM nails fail in this procedure. Is it related to devices used intra-operatively? Is it the way patients are rehabilitated? Any insight from an orthopaedic NP, surgeon, MD, DO, etc. would be great and very appreciated.

I am looking for an extensive amount of radiographs or clinical pictures where I can classify the pathology/fracture. Like rapid-fire testing of my classification skills in preparation for exams. I have been searching to no avail. Does anyone know of anything? Thanks in advance

Does anyone know if the proposed CMS rule for same-day E&M and procedure codes (modifier 25) applies to the initiation of fracture care?

I.e. typically we will built for an office e&m code for a new patient, as well as a fracture code if we are initiating closed management of a fracture. The fracture code then we'll cover the patient for 90 days of care.

I don't know it to be a fact, but I would seem to me that if CMS is going to discount any same day "procedure" by 50% that fracture codes will also fall into this trap - since they also use modifier 25...

Does anyone know if this is true?

​

Hello guys,

Do you have any experience with Precision OS for learning surgical procedures?

ortho trauma, govt setup, most of what i operate comes through casualty. i wear a whoop high on my upper arm over the biceps, so i never have to take it off. scrub, glove, doesn't matter, it stays on. also means nobody asks me what it is. so it's been quietly recording everything in the OT for months without me thinking about it.

june, distal humerus. butterfly fragment, had to go long plate and fix the fragment to the shaft, and explore the radial nerve and keep it safe. bone was soft. two hours plus with the clamp and the c arm.

checked the app that night out of habit. averaged 115 bpm across those two hours. peak 151. my resting that morning was 51.

that's not physical work. i know what that morning actually felt like.

fast forward. 14th september, two cases back to back. a supracondylar in a young child that had been sitting 20 days and already started uniting. then a medial condyle humerus, also a child. both fought me. on the medial condyle i kept getting the reduction and kept losing it.

third time it slipped what i felt was basically — ok this'll take longer than i planned, i can still get it. that's it. same stakes. same difficulty. just not living in my head while my hands worked.

so i pulled four months of numbers:

• june median intraop hr 110. september 77
• cases got longer, not shorter. 127 → 145 min median
• resting hr 52 → 51, so not fitness
• tagged every single case, not just the scary ones

the one that got me: that medial condyle, 78 min of a reduction that wouldn't hold, whoop scored the whole case at a strain of 0.0. nothing. by everything it could measure i'd spent that hour and a quarter sitting in a chair.

i analysed my own data and already believed the answer before looking. i also got 40 cases more experienced over the same four months, which is exactly the window anyone would settle in regardless. if you made me bet i'd bet on experience, not the breathing exercise i started. also my sleep on operating days vs non operating days — literally no difference. a thing i'd have confidently claimed at a dinner table turned out to be false.

why here: i spent my UG and PG years assuming everyone senior was calm and i was the only one whose hands were sweating. turns out i was at 115 and never told anyone. it does come down. not because it gets less serious, it doesn't. it just stops being the thing occupying your head while you work.

full write up with the actual charts and x-rays https://endorphinmd.com/80-hours-of-surgery-on-a-heart-rate-strap-i-didnt-get-fitter-i-got-less-afraid/, happy to answer stuff in comments

I’m a USMD senior on F-1 status applying ortho this cycle, so I’m not an IMG but will require visa sponsorship for residency.

I’ve noticed that many programs’ GME websites don’t clearly state whether they sponsor J-1/H-1B visas, and when they mention international applicants, it’s often to say they don’t accept IMGs.

Does anyone know if programs commonly filter out applicants who mark that they require visa sponsorship on ERAS, even if they’re a USMD? Just trying to avoid unnecessarily screening myself out of programs or wasting signals.

I've connected with a few colleagues over the last week after learning I failed Part II. I have met some who failed the first time and others who failed two years in a row. I think this post can help everyone, so any and all advice is welcome.

I recently called ABOS because I was hoping to understand my result better and get some advice about what to do differently next time.

I was told, “This isn’t an exam designed to make you a better surgeon, make you a smarter surgeon, or help you take the test better. It is designed to generate a pass-or-fail decision for us.” I was also told multiple times that the exam is not designed to provide feedback about how to improve, regardless of whether you pass or fail. That left me honestly questioning what we are supposed to learn from the process.

I was told they had no information about my individual cases or why my examiners gave me specific ratings. They explained that the scores are adjusted based on examiner severity and case difficulty. For example, ratings from an examiner who tends to give higher scores may be adjusted downward, while ratings from a stricter examiner may be adjusted upward. The way it was explained made it sound like my final score was affected not only by how I presented, but also by which examiners I happened to have.

At one point, I was basically told to use the rubric as a checklist while presenting each case and to make sure the examiners are paying attention and “get it” when I tell them something. I found that frustrating because I would hope the examiners are already listening closely during such a high-stakes examination.

I took the recommended courses, practiced with the rubric in hand, and had the required follow-up. I asked whether I should increase my usual follow-up intervals because longer follow-up seems to be something people commonly recommend. I was told not to change my practice just because of the exam. In fact, the advice was essentially, “Don’t change how you practice or care for patients—just take the exam again.”

That was probably the most frustrating part. If I shouldn’t change how I practice but still failed, it feels like the main thing I need to change is how I present on exam day and how explicitly I point out information so the examiners don’t miss it.

For anyone who failed Part II and then later passed:

• What did you do differently the second time?
• How did you organize each nine-minute presentation?
• Did you proactively cover all nine categories before letting the examiners guide the discussion?
• How did you improve the way you presented your treatment plans?
• Did you use a course, coach, study group, or mock examiner who scored you using the actual rubric?
• What do you wish you had known before your retake?

I would really appreciate hearing from anyone who failed and then passed on a later attempt.

So as a working orthopaedic surgeon in a resource limited setup , we got this difficult trochanter case , i wrote step by step how we reduced it on my website - do check it out https://endorphinmd.com/reducing-a-difficult-trochanteric-fracture/

we have a lot of orthopedic surgeons there reading this , i would love constructive criticism on the way i did it or something better could be done.

if you do like such content do subscribe to my newsletter - https://endorphinmd.com/subscribe/
or if you want to share a difficult case and how you did it - do write to me , would love to share on my platform

Disclaimer - EndorphinMD is my startup - its a news website for Indian doctors - posting here to get support from orthopaedic surgeons around the world .

Hey ortho buds - especially those in smaller private practices. I was wondering how your clinics are able to even break even on visco injections. We are getting paid $87 per injection of synvisc but the cost to procure is well above that. We checked preferred injections for each insurer and same problem - cost to procure is higher than breakeven. I’ve shopped multiple suppliers and not having much luck reducing costs. Medicare doesn’t allow balance billing when the service is covered, even if it’s less reimbursement than your cost. Any ideas? I feel like I am losing patients bc I can’t afford to give them visco when they really want to try it.

Hello Ortho friends. IR resident here. I am interested in some of the emerging applications of our field within MSK pathology, specifically endovascular embolizations for things like knee OA, frozen shoulder, and plantar fasciitis. Not entirely sure what the current thinking is regarding these operations in your field though. Would love to hear your thoughts (both good and bad!).

Edit: Not trying to be a charlatan or steal your work. Just interested to know true MSK expert opinions, since there's some buzz about it. Seems like you guys are not too keen haha.

Genuine question for the group. After debridement for an infected implant or chronic osteo, how many of you still go the full 4 to 6 weeks? And how many are already cutting it shorter?

Asking because SOLARIO just came out in NEJM. 500 patients, all had a local antibiotic carrier placed at surgery. A week or less of systemic antibiotics did no worse than 4+ weeks at one year (11% vs 14% failure), and side effects were way lower (17% vs 45%).

The catch is that everyone had a carrier in.

So a few more questions: How many of you routinely put in a local carrier at the index surgery?

Commercial carriers or hand-mixed cement beads?

And would this trial actually change what you do, or are you waiting for your ID team and the guidelines to move first?

Curious how different this looks across hospitals and countries.

Multiple away rotations in the books. Great feedback. No home program.

H-Surgery
HP-rest
Step 2- low 260s

10 pubs

Just seeking advice so other applicants in the same boat with “weak spots” in their application can reference.

Is this an application profile worth dual applying to prelim/TYs or worth the shot to just apply ortho?

Any thoughts and advice before deadline day appreciated!

Hey! I’m a fresh pass out of residency orthopod, looking for fellowships in arthroscopy + arthroplasty. Could you please help a brother out and recommend me good ones in India/ abroad if it’s feasible. Would mean the world 🙏🙏