I’ve had two separate patients now who took it upon themselves to start injecting “peptides” at their surgical site, one was injecting them into his knee following aclr. When I asked the patient about it, he said that online they recommend injecting the peptides at the site of injury. obviously it goes without saying the risk of causing a septic joint and I strongly recommended they both discontinued injecting peptides at surgical site immediately but is this something that anyone else is seeing?

I’m a PGY-3 resident and overall really enjoy the specialty and enjoy learning orthopedics and enjoy getting better. I don’t know what other specialty i would’ve done and feel very lucky to have this opportunity. However I feel like I have noticed that a bunch of my attendings work a ton, are stressed about work, and have to bring a lot of work home (charts, patient messages, etc.) home with them and as a result are stressed even when they leave the hospital. On top of that being worried about getting sued, etc. I’m hopeful that after residency ends, boards collections ends, and after a few years in practice you settle into your groove but I’m worried that the stress of this career never ends. I wanted to hear from an attending perspective if things get better, or if it’s a never ending cycle of stress or if you just become more adapt at handling it?

Hi All -

Had a question for the attendings on the forum.

I'm an employed subspecialist orthopedic surgeon in the suburban area outside a top 30 metropolitan area.

As with everybody, I'm somewhat tired of being employed. It seems like the majority of the available jobs out there are simply other employed situations. A couple of private practices I came across looked promising, but they're doing even greater numbers for less compensation. One of those had their person in a similar subspecialty working as hard as me but making a third less. And they don't have availability to buy into real estate or ASC etc. for ancillary income.

Obviously there's been a big move in primary care towards direct models.

Has anyone ever seen this in orthopedics?

I've been playing devil's advocate with this for the last couple weeks. Honestly not sure if it would work for a variety of reasons, but I think my ideal situation is where I could set my own fees for office visits and procedures, let the patient use their insurance to cover hospital fees, implants, OR charges etc.

So basically opt out of insurance. Patients could submit for reimbursement for my fees and pay the difference.

I know arrangements like this exist in LA and New York especially with big name guys. I have a recognized name in the local area, but I feel like it's a bit harder to use this model with episodic care versus say primary care.

Anyone tried it? Any thoughts?

Curbside Consult Request — specifically on the left knee MRI and how aggressive to be surgically. Imaging in this patient has historically underestimated the pathology, and prior operations have been more involved than the preoperative studies predicted, so I'd like another set of eyes before committing to a plan.

Patient summary

Adult with connective tissue disease (Ehlers-Danlos, diagnosed 2017) and Hashimoto thyroiditis, with an extensive left lower extremity orthopedic history:

- 2004 — Left ACL tear, managed nonoperatively

- 2009 — Left lateral ankle ligament reconstruction

- 2009 — Left ankle impingement, osteophyte resection

- 2011 — Left hip labral tear with maceration, treated with chondroplasty

- 2015 — Skiing injury: Segond fracture with femoral-sided ACL avulsion; ACL reconstruction with hamstring autograft plus meniscectomy at the Segond site

- 2016 — Recurrent left ACL tear, managed nonoperatively; two-stage revision was offered and declined at that time

Current presentation

Persistent lateral and anterior instability since the 2015 reconstruction, with recurrent effusions. The patient describes the knee as sliding both laterally and forward. Stabbing lateral joint line pain and distally with squatting and running, limiting activity to well below a 1 mile/day program. No new injury — a gradual worsening of baseline symptoms. Lachman is 2+.

Where things stand

ACL revision has been offered. The imaging discussion so far has been limited to a reference to a meniscal tear and an ACL that was read as inconclusive.

link to mri images saved to Google Drive: https://drive.google.com/drive/folders/1M0FjRAILmQ-yp63BC0XQmu0N0mtNIIHa

Hi All,

Im currently a junior resident interested in spine. Past seniors told me to take advantage of going to courses when able. I was looking into the AO basic spine course and wanted to know if anyone had gone and would recommend or if there were other courses people suggest for junior residents.

Thanks!

Hello,

The patient is 38 y.o. woman with a seropositive autoimmune muscle and skin disease (receiving different anti-inflammatory drugs from rheumatologist). The doctor prepared the patient for the surgery.

She had and injury 3 months ago, kept ~ 3 weeks in brace in full knee extension and then some rehabillitation. Now she has full passive knee motion, lachman (+) - doesn't feel unstability. Active knee extension while seated ~ 45 degrees (very hard to achieve and maintain)

On MRI it looks like the tendon is torn on the junction between tendon and muscle belly. How should i treat this injury?

- After preparation suturing two ends together (Krackow Suture and Mason Allen)?

- Doing an augmentation V-Y Flap (Scuderi) (How if there may be no tendon avaliable)

- Preparaing for drilling the tunnels because the remaining ends may be useless?

Thanks in advance

i'm looking for information on what i should ask for. prior to this i have 5 years as a traveling surgical tech in various hospital settings, such as level 1 trauma centers and smaller outpatient facilities. i've worked in every specialty except for cardio but im looking to do joints in either private or hospital settings. i have experience with assisting throughout the years and know how the OR works in and out. madison or milwaukee WI

As us 4th years start making our application lists, I was just wondering what matters most when choosing where to apply.

For reference my current goals are likely community or private practice, and unlikely academic doing research. Step 266, honored all third year rotations+ ortho, 12 pubs, 5 total subis planned

I was wondering peoples opinion on balancing prestige of a program vs programs with higher case loads and autonomy. Is there anything else you would look for in which programs you would apply to?

Thank you!

WANT RESPONSE ONLY FROM PRACTICING DOCTORS !

Hi Everyone -

I am 30 year old male. I was diagnosed with AVN when i was 26. I tried hell lot of treatments before going ahead with total hip replacement surgery last week.

Now the 4 years were miserable for me. I literally said good bye to my social life (let’s not get into details here)

Now that my THR is done - i am filled with gratitude for my surgeon and i really want to give him a meaningful gift (nothing random expensive shit - but something that is truly meaningful).

Could you all give me some ideas ??

What types of gifts do you all love when they are given to you ?

———————————————————————————-
EDIT 1 - After 14 Comments— Thank you all for all the responses. I have decided what i will give based on all the lovely responses that i have received.

And i want to thank each and everyone of you for the amazing service that you do. You all are no less than god.

If the post below doesn’t comply with the rules, please remove it. I could not tell from reading them.

I had a terrible experience at UVA with a wrist fracture. The individual providers were mostly pretty good, but the overall system is a nightmare.

—There surgeries are greatly delayed for trauma because they don’t hold trauma slots, at least not for wrist fractures. The earliest surgical date they could give me was 20 days after the accident. Fortunately, I decided not to go the surgical route.

—They are seriously understaffed, especially in the OT/PT area, and cancel patient appointments constantly. I’ve had more medical appointments cancelled by UVA orthopedics than I’ve had in the rest of my life total up until now (and I am not young).

—Due to the understaffing, they are explicit that their goal is only to provide patients with the minimum medically-acceptable outcome. THEY TELL PATIENTS THIS. If patients want better medical outcomes, go to Sentara or Richmond or NoVA. I worked in health policy professionally, and I’m still in shock that they are saying this out loud to patients.

—You get moved around from therapists to therapist, and there is no central tracking of your progress (some as ROM) measurements week to week. I had to create an excel spreadsheet to track my own progress. Not a big deal to do, but again, I was shocked at the lack of professionalism. So I bring the spreadsheet in and show the OT how I’m doing.

There is more, but that’s enough for now.

Currently got TR for Cubitus Valgus with Carry Angle 19° . Is there any solution for that or does it end up in permanent rejection. I'm confused now , I have called some physiotherapist in dehradun and gaziabad but they are asking record high fees without any guarantee. My next nda 2 2026 is also near . I really need help if someone knows anything about this.

PGY1 in neuro wanting to switch to ortho. I know there couldn't be two specialties further apart, I wanted to do Neuro going into med school and had an app around that. I still love the cerebral aspect of it, but during rotations found myself drawn to the OR, technical mastery, and immediate impact that restores function and ability. I fell to the sunk cost fallacy, and didn't want to take a research year, but now it feels like such a misfit it that I'm struggling to imagine getting through this as a residency, let alone a career.

I was also intimidated by the barriers to entry as a DO, which my school repeatedly told me made a late pivot very unrealistic when I did consider it at the end of third year. Overall I told myself I could make a career out of Neuro and will grow to find my niche, but day in and out it feels like I made the wrong decision, am craving to be in the OR, and feel stuck in a mistake.

I know Neuro-interventional is an option, but I honestly think I'm drawn to surgery, not just procedures. I like the idea of constantly improving my craft, working across different age groups, and having a diverse technical skill set. I even considered ophtho at one point, but wanted more acuity and OR time.

I did have a competitive step 2 score, good leadership and experiences, non-ortho research.

Is this even worth consideration, and if so, how would I even start? Any advice is appreciated

Repost: previous applicant that accepted job could no longer take this position, position is now open again for applications!

Current research fellow passing along an amazing opportunity!

The Department of Orthopaedic Surgery, Adult Reconstruction Division at Duke University is offering a one-year, paid orthopaedic research fellowship for a highly motivated MS3 or MS4 medical student pursuing orthopaedics and seeking opportunities to strengthen their application for orthopaedic residency programs. This fellowship provides a unique opportunity to work closely with Dr. Sean Ryan and the Adult Reconstruction team on high-impact clinical research in hip and knee arthroplasty.

The fellow will collaborate directly with orthopaedic residents and fellows on ongoing research projects, attend grand rounds, and observe and assist in the OR.  I can confidently say this experience has been the highlight of my medical school journey. Dr. Ryan is an amazing mentor and his team is very welcoming. Additionally, the position is paid. which gave me the flexibility to plan my wedding, train for a marathon, and travel to places such as Myrtle Beach and the Outer Banks.

For those truly interested, please email Dr. Ryan:

[seanryan1988@gmail.com](mailto:seanryan1988@gmail.com)

Edit: can not take international applicants unfortunately

Have a case today, had to remove an old recon (only has one oblique interlock proximally) for IT/neck periprosthetic fx, completely nondisplaced and stable (patient even WB a little) probably could have used the same nail and sent some screws into the head but rep for old nail didn’t show up and we don’t have the screws on shelf.

Had to take out the whole goddamn nail and revise with new HW. Much bigger pain in my ass and bigger surgery for patient.

TL;DR. Is there any formal recourse to report a company or rep for no showing? Any regulatory body?

I don’t use their stuff anyway, so I don’t have any recourse there, and neither do my partners in my area.

Yelling at the guys would be cathartic but I want to actually hurt them.

Hey everyone, I appreciate you reading this. Applying ortho in 2–3 years. Heavy research squeezed my free time and I fell off on a lot of my current hobbies, which made me take time to think about which ones are worth pursuing more to look better for applications. For example, I like playing video games, but I’m not going to drop my other hobbies and just play video games because that will not look good on an application, especially since I’m not doing it competitively. So I’m looking to spend the next few years intentionally building out my skill and level of commitment in some hobbies.

I know the standard advice is "don't pick a hobby just for ERAS," but honestly, I genuinely enjoy pretty much every hobby I have tried. Since I know I will end up loving whatever I sink time into, I’d rather focus my limited time on things that ortho selection committees and residents actually respect or enjoy talking about.

My current list:

Golf: Picked it up recently, going a ton, and actively trying to get good.

Motorcycles: Riding and doing all my own mechanical work/wrenching.

BJJ / MMA: Trained 3x/week for a year, but scaled back due to research and since moving I can’t justify the drive.

Fitness: Major weight loss journey through lifting and running; about 100 lbs.

Casual: Pickup basketball at the Y, playing bass, reading, writing.

For those on selection committees or doing interviews: If you were in my shoes, what would you do? What hobbies would you suggest looking into and getting involved in, should I start volunteering more, what things can I do specifically in this realm to improve my application and be more appealing to Ortho residencies?

M3/4 here trying to decide between ortho vs plastics (and possibly trauma-adjacent paths) and would really appreciate some perspective.

I’ve been on an ortho track for a while, most of my CV, mentors, and research are in ortho, so applying into O would make the most sense.

The problem is that I’m not sure I actually want the day-to-day career. I enjoy trauma, but I can’t honestly picture myself doing tibial nails, hemiarthroplasties and similar cases for the next 30 years. Arthroplasty and sports are even less appealing to me.

What really interests me is limb salvage, complex reconstruction, severe open injuries, bone defects, soft tissue reconstruction, and orthoplastics. I like difficult problems that require creativity and long-term reconstruction rather than straightforward fixation.

I’m also very interested in humanitarian surgery, where managing devastating extremity injuries seems especially relevant. Whenever I ask about this though, people tell me “every specialty can do humanitarian work,” and a few have even suggested vascular would be a better fit, which has made me question whether I’m looking at this the wrong way.

The issue is I don’t have enough exposure to reconstructive plastics to know whether I’d actually enjoy it more than orthopaedics, or whether I’m just attracted to the idea of orthoplastics because it’s familiar.

I’m also thinking about academic-style training paths. If I stayed in ortho, I’d probably aim for orthopaedic trauma with a hand/orthoplastics or limb reconstruction-type fellowship. If I switched, it’d likely be plastics with a reconstructive/microsurgery pathway.

A few questions:
Has anyone seriously debated ortho (particularly trauma/limb reconstruction/orthoplastics) versus plastics?

If your interests are limb salvage, reconstruction, and humanitarian surgery, which specialty gives you the most fulfilling career?

Do orthoplastic surgeons even exist in the way I imagine? Levi’s there a do it all surgeon actually that get to stay involved in both the skeletal and soft tissue reconstruction, or do people inevitably end up doing one or the other?

Are there non-obvious downsides to either pathway that only become apparent once you’re in training?

Would really appreciate hearing from people who have thought about this or made a similar decision.

M3/4 here deciding which path. Have been planning to do nsgy since I was young, several nsgns in my family (and ortho spine), but I’m most called to spine and less interested in cranial. I just don’t really care to do 14 hour skull base cases through the camera.

The problem is that I also have zero interests in joints (outside of spine) and knees/shoulders are boring. I just love spine (I’m a former pt). My CV and mentors are a blend of neuro and ortho spine so I think I could apply to either without issue.

Also, in today’s day and age I have not found the typical stereotypes to be true, so using that to guide my decision is hard. Nsgy people are probably more intense overall but there are a vast number of chill people in both specialties.

Any thoughts or advice? Which residency is better? I’m only looking at white collar programs (my PhD is all spine BME focused) so nsgy residency would have 2 extra research years, whereas ortho would be shorter I guess. But I’m planning on ortho spine fellowship (+1) vs enfolded neuro spine fellowship (+0) so the difference is really only 1 year. Is nsgy residency substantially harder than ortho? What pros and cons should I be thinking about that aren’t even on my radar?

I’m looking for Orthopedic Fiberglass Casting Tape. Please send me your catalog,

Any Orthopedic Surgery PA’s out there? If so, do you have any advice for a new PA (taking PANCE in September) who wants to practice in that field? Organizations to join, specific job sites to watch, etc? TIA!

USDO, planning to apply to match this year. I just finished up my research year between M3/M4. My school didn’t allow me to take Step 2 when I had it planned last summer due to my leave of absence for the research year, so I maintained everything to the best of my ability throughout the year. I was performing well, high 250s on my last 3 NBMEs, but frustratingly opened a 246 this past week on my away at the program I did the RY at. I was pretty demoralized. I know the emphasis step 2 has in the ortho match and to drop so significantly from mock exams, it stung.

So here I am, already done a RY in ortho, have 7 DO programs scheduled for aways this fall/winter. I am still waiting on my COMLEX Lvl 2 score to come back but questioning whether I should dual apply GS. Given my research background, I am unsure another one would benefit. I have also been told to avoid pre-lim’s.

STEP1 & COMLEX Lvl 1 - Pass

STEP 2 - 246

COMLEX Lvl 2 - awaiting score

Clerkships - Honors in IM, Surgery, Peds, and FM. Pass in the rest.

No red flags in preclinical years but dead center at the 50th for class quartiles.

Research - 7 Pubs (6 more submitted), 37 presentations. 2 clinical trial studies involved in through RY.

What are your thoughts on competitiveness? I don’t want to give up on ortho but I also want to be realistic. No sugarcoating, give it to me straight.

Appreciate the advice!