The drawbacks of orthopedic surgery?

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We all know 100 reasons why ortho is an awesome specialty, but what are some of the things that raise your blood pressure in this field? Brutal residency? Workers' comp? Over-specialization? Stank 'breff anesthesiologists?

Give us an idea of what made you think twice about your specialty of choice.

I can't think of any ortho specific drawbacks, just the same as any surgical specialty.

The hours blow during residency - you're always tired. I don't know if this applies stateside - I'm in Canada and there's no 80 hour rule. We just switched to a night float and my life got ridiculously better.

Adult spine clinic.

Arthroplasty rotations after you've done a few, remembered how to do them, and remembered why you have no interest in putting in joints when you're done.

Turning into an ******* when on trauma rotation (aka "trauma rage").

Over-specialization. I would have loved to have come through 20 years ago.

Old-school staff guys and their knuckle dragging mentatlity.

HOWEVER - I love my job.

My old lady is a podiatrist attending now. The fact that her and her cronies think they can manage hindfoot and ankle trauma better than orthopaedist chaps my ass.

We don't talk about work at home.

To be fair, her entire field is devoted to the foot. Can't really blame her for thinking erroneously.

Originally Posted by Chakrabs

To be fair, her entire field is devoted to the foot. Can't really blame her for thinking erroneously.

More like her whole field is devoted to operative management of the forefoot and nonoperative management of the hindfoot.


Some of the **** her attendings did made me throw up in my mouth.

Originally Posted by Buckeye(OH)

More like her whole field is devoted to operative management of the forefoot and nonoperative management of the hindfoot.


Some of the **** her attendings did made me throw up in my mouth.

Next time throw up in your wife's mouth. She'll learn quick

I've been thinking about this topic since it was posted. I really can't think of anything.

I kind of miss some of the cardio/pulmonary/renal/electrolyte physiology, but that is unique to me. And I probably only miss it because it isn't my problem.

Originally Posted by Chakrabs

To be fair, her entire field is devoted to the foot and ankle. Can't really blame her for thinking positively.

Fixed that for you.

Originally Posted by Buckeye(OH)

My old lady is a podiatrist attending now. The fact that her and her cronies think they can manage hindfoot and ankle trauma better than orthopaedist chaps my ass.

We don't talk about work at home.

Hmmm weird. I guess those hand specialists in your field do a lot of F&A trauma do they?

Originally Posted by Buckeye(OH)

More like her whole field is devoted to operative management of the forefoot and nonoperative management of the hindfoot.


Some of the **** her attendings did made me throw up in my mouth.

Probably half of the cases I see are hindfoot. Not hindfoot trauma, but hindfoot none the less.Weird. Aren't we all on the same team?

Originally Posted by Kidsfeet

Probably half of the cases I see are hindfoot. Not hindfoot trauma, but hindfoot none the less.Weird. Aren't we all on the same team?

We were on the same team until smashed calcaneus fracture that comes in during working hours go to the podiatry resident that's taking home call over the in-house orthopaedic resident. Funny how the smashed calcaneus that comes in at 3 am doesn't get a podiatry consult.

So no, we are not on the same team.

Originally Posted by Kidsfeet

Hmmm weird. I guess those hand specialists in your field do a lot of F&A trauma do they?

I would love to engage myself in this line of arguing, except, I cannot make it make sense in my head.


What's weird is poditrists doing high tibial osteotomies. I was at ACFAS two years ago (vacation for me, conference for her, I went to some lectures)...explain where the foot and ankle expertise in that is?

Originally Posted by Buckeye(OH)

We were on the same team until smashed calcaneus fracture that comes in during working hours go to the podiatry resident that's taking home call over the in-house orthopaedic resident. Funny how the smashed calcaneus that comes in at 3 am doesn't get a podiatry consult.

So no, we are not on the same team.

Funny. In my neck of the woods it's exactly the opposite. Seems like all the reasonable hours cases with insurance tend to land in the Ortho's lap and the no insurance, 3AM MVA end up in ours.

Sorry, but yes, we ARE on the same team.

Originally Posted by Buckeye(OH)

I would love to engage myself in this line of arguing, except, I cannot make it make sense in my head.


What's weird is poditrists doing high tibial osteotomies. I was at ACFAS two years ago (vacation for me, conference for her, I went to some lectures)...explain where the foot and ankle expertise in that is?

Tibial positioning has an effect on foot and ankle function? Moving the tibia has a direct effect on the mechanics of the ankle joint and position of the tibia plafond can have a translational effect on not only the Ankle joint axis but the the Subtalar joint axis as well.

Once again, not nearly as weird as Orthos who do only hand in their offices but are on general ortho call in the ED. I can't make it make sense in my head either, but it happens all over the place and everyday. Sorry, but I would rather have a Podiatrist fix my ankle fracture rather than someone who hasn't seen one since their trauma rotation in residency 20 years ago, but got stuck with call because that's what the hospital requires. Yeah, I know, the politics will make your head spin. I've been on ED committees and these things happen all the time. Some communities don't have foot and ankle trained Orthos around but plenty of Podiatrists who are well trained to care for foot and ankle trauma, but don't get ED call. Care to explain that one?

Originally Posted by Kidsfeet

Tibial positioning has an effect on foot and ankle function? Moving the tibia has a direct effect on the mechanics of the ankle joint and position of the tibia plafond can have a translational effect on not only the Ankle joint axis but the the Subtalar joint axis as well.

Once again, not nearly as weird as Orthos who do only hand in their offices but are on general ortho call in the ED. I can't make it make sense in my head either, but it happens all over the place and everyday. Sorry, but I would rather have a Podiatrist fix my ankle fracture rather than someone who hasn't seen one since their trauma rotation in residency 20 years ago, but got stuck with call because that's what the hospital requires. Yeah, I know, the politics will make your head spin. I've been on ED committees and these things happen all the time. Some communities don't have foot and ankle trained Orthos around but plenty of Podiatrists who are well trained to care for foot and ankle trauma, but don't get ED call. Care to explain that one?

Thank you for enlightening me on the fact that proximal tibial position affects foot and ankle biomechanics. That was not the point of the statement. The point of the statement was the fact that, the proximal tibia is neither part of the foot, nor the ankle. Hence, it should not be an area the podiatrists operate.

Why would I try to explain the fact that podiatrists are not getting the ED call in areas where there are not foot and ankle trained orthos? That should be a point that you are trying to explain. Im fine with that.

Originally Posted by Buckeye(OH)

Thank you for enlightening me on the fact that proximal tibial position affects foot and ankle biomechanics. That was not the point of the statement. The point of the statement was the fact that, the proximal tibia is neither part of the foot, nor the ankle. Hence, it should not be an area the podiatrists operate.

I figured since it directly affects the foot's function it would fall under our scope as an adjunct structure. Much like the Achilles Tendon. When dealing with a Charcot Reconstruction, many times a TAL is virtually required to assure success of the procedure in preventing long term breakdown and future ulceration prevention.

Why would I try to explain the fact that podiatrists are not getting the ED call in areas where there are not foot and ankle trained orthos? That should be a point that you are trying to explain. Im fine with that.

So you're OK with a population being served in an Emergency situation by a non expert, when there are plenty of experts around who can do a better job? Interesting. I hope I don't have a Talar Neck fracture or Pilon Fracture in that town!

Originally Posted by Buckeye(OH)

Funny how the smashed calcaneus that comes in at 3 am doesn't get a podiatry consult.

Who is responsible for calling Ortho at 3am vs Podiatry? Are you insinuating that Podiatry is declining these calls or that the ED is giving preference to Pod? What exactly are you saying?

Originally Posted by janV88

Who is responsible for calling Ortho at 3am vs Podiatry? Are you insinuating that Podiatry is declining these calls or that the ED is giving preference to Pod? What exactly are you saying?

Who the hell cares. If you guys want to continue to fight about this, do it in another thread. You can call it "Podiatry vs Ortho Pissing Contest"

This argument is hilarious.

Originally Posted by Kidsfeet

Hmmm weird. I guess those hand specialists in your field do a lot of F&A trauma do they?

One drawback to ortho is having to deal with guys like this. We catch a lot of crap for being a bunch of meatheads jocks, etc. But then again even a meathead can diagnose a DOUCHEBAG with an inferiority complex.

For claiming to be so intelligent, blah blah blah you sure do make some stupid comments. You need to remember that orthopods are trained to deal with ALL musculoskeletal injury from the finger tips to the toes, including the spine. That is why my residency is 5 years and yours is 3years. Not to mention that most orthopods do a fellowship which is a whole year of extra training in the subspecialty of our choice. Just because we choose to undergo another year of subspecialty training in hand, total joint replacement, sports, trauma, spine, or what have you doesn't mean we have forgotten the very basic principles taught us in residency and in our experiences beyond residency. In my future practice will I ever venture into an OR for definitive fixation of a Hawkins 4 Talar neck fracture? No, but I sure as hell can take it for reduction and external fixation until my F/A or Trauma specialist partners can address definitive fixation. You need to known what the hell you are talking about before you go making outrageously stupid claims/accusations. You make stupid remarks like these without thinking them through and then claim to be "on the same team?" No...we're not on the same team. Bottom line, know your abilities and known your limits. Know your scope and do your best within your scope to help patients.

Scoot's forecast of future events:

KIDSFEET will retaliate with some stupid comment about how Orthopaedic F/A fellowships are all taught my Podiatrists and have no F/A orthopod atendings... blah blah blah. He'll quote some AMA literature, but fail to actually provide proof that the article exists. However, before that he'll use his Admin/Mod status to enforce some sort of disciplinary action on my account and claim that it's due to use of inappropriate language so I can't call him out on his BS after his next post.

Cheers,

SD

Originally Posted by DHT

Who the hell cares. If you guys want to continue to fight about this, do it in another thread. You can call it "Podiatry vs Ortho Pissing Contest"

Not to digress, and I don't think it's ever a pissing contest, but ortho and neuro share spine. How come you guys mostly stay away from intradural tumors?

Originally Posted by neusu

Not to digress, and I don't think it's ever a pissing contest, but ortho and neuro share spine. How come you guys mostly stay away from intradural tumors?

Because "nothing good happens inside the dura." Intradural tumors are not really part of ortho spine training. Ortho tends to focus on large deformity cases rather than intradural pathology (which tends to be exceedingly rare). Im sure there are orthopaedic surgeons somewhere that do intra-dural stuff but it would be because they did a neurosurgically inclined fellowship, just like how there are neurosurgeons out there doing deformity cases who had an orthopaedically inclined fellowship (ex: Cleveland Clinic is a combined Ortho/Neuro spine fellowship). The bottom line is that spinal cord tumors probably account for 0.1% of spine cases (probably less). They will all be sent to a super-sub-specialist at a large tertiary center. And to be honest, I doubt many people are clamoring for the cases where the preop conversation lets the patient know they will wake up paralyzed without control of their bowel or bladder.

The relationship between ortho and neuro spine is different everywhere. Some places are better than others. However, wherever you both sides will likely take jabs at the other, but its rarely a pissing contest. I think the reason for this is that ortho and neuro are roughly equivocal in training. Both require 10+ years after undergrad, went to medical school, and completed a grueling surgical residency. This contrasts greatly to the anesthesia vs CRNA or ophthalmology vs optometry scope of practice debate.

Originally Posted by Kidsfeet

So you're OK with a population being served in an Emergency situation by a non expert, when there are plenty of experts around who can do a better job? Interesting. I hope I don't have a Talar Neck fracture or Pilon Fracture in that town!

And I hope I don't have a pilon or talar neck fracture in a town where these are treated by a podiatrist. I'd rather the on-call physician puts a frame on it or splints it and sends me to a real expert. An experienced orthopaedic traumatologist or orthopaedic foot/ankle surgeon.

Originally Posted by ddmo

And I hope I don't have a pilon or talar neck fracture in a town where these are treated by a podiatrist...experienced foot/ankle specialist.

Dude, WTF are you talking about??!! BWAHAHAHAHAHAHAHA....

Originally Posted by ScootDoc

One drawback to ortho is having to deal with guys like this. We catch a lot of crap for being a bunch of meatheads jocks, etc. But then again even a meathead can diagnose a DOUCHEBAG with an inferiority complex.

For claiming to be so intelligent, blah blah blah you sure do make some stupid comments. You need to remember that orthopods are trained to deal with ALL musculoskeletal injury from the finger tips to the toes, including the spine. That is why my residency is 5 years and yours is 3years. Not to mention that most orthopods do a fellowship which is a whole year of extra training in the subspecialty of our choice. Just because we choose to undergo another year of subspecialty training in hand, total joint replacement, sports, trauma, spine, or what have you doesn't mean we have forgotten the very basic principles taught us in residency and in our experiences beyond residency. In my future practice will I ever venture into an OR for definitive fixation of a Hawkins 4 Talar neck fracture? No, but I sure as hell can take it for reduction and external fixation until my F/A or Trauma specialist partners can address definitive fixation. You need to known what the hell you are talking about before you go making outrageously stupid claims/accusations. You make stupid remarks like these without thinking them through and then claim to be "on the same team?" No...we're not on the same team. Bottom line, know your abilities and known your limits. Know your scope and do your best within your scope to help patients.

Scoot's forecast of future events:

KIDSFEET will retaliate with some stupid comment about how Orthopaedic F/A fellowships are all taught my Podiatrists and have no F/A orthopod atendings... blah blah blah. He'll quote some AMA literature, but fail to actually provide proof that the article exists. However, before that he'll use his Admin/Mod status to enforce some sort of disciplinary action on my account and claim that it's due to use of inappropriate language so I can't call him out on his BS after his next post.

Cheers,

SD

Meathead...check...

Douchebag...check...

Moron with a HUGE chip on his shoulder...check...

Cut the God complex d-bag..jeez...

Originally Posted by DHT

I've been thinking about this topic since it was posted. I really can't think of anything.

I kind of miss some of the cardio/pulmonary/renal/electrolyte physiology, but that is unique to me. And I probably only miss it because it isn't my problem.

Would this be more under the realm of general surgery?

Originally Posted by JackShephard MD

Would this be more under the realm of general surgery?

Yeah, general surgery/trauma/surgical critical care.

Originally Posted by Kidsfeet

Dude, WTF are you talking about??!! BWAHAHAHAHAHAHAHA....

My definition of a foot/ankle specialist is a fellowship trained orthopaedic surgeon, not a podiatrist. That is what I am talking about. I edited the previous post to reflect this.

Originally Posted by ddmo

My definition of a foot/ankle specialist is a fellowship trained orthopaedic surgeon, not a podiatrist. That is what I am talking about. I edited the previous post to reflect this.

the above meme is sheer awesome! epic win! and I dont know who its burning worse....:sly:

Sent from my SPH-D600 using SDN Mobile

Originally Posted by MaxillofacialMN

Yeah, yeah. Enjoy yourself with all those diabetic foot ulcers my friend. I'm sure they'll make for a very fulfilling career... Give Ortho a call when you get in over your head and/or when your patients need real surgical management of MSK issues of the foot/ankle as well as all other surgical MSK needs.... above mid-shaft tib/fib of course since we all know that beyond that DPMs have no business.

Cheers

SD

Wait for it........ wait for it.........and.... cue Kidsfeet attempt to retaliate.....

Originally Posted by ScootDoc

Yeah, yeah. Enjoy yourself with all those diabetic foot ulcers my friend. I'm sure they'll make for a very fulfilling career... Give Ortho a call when you get in over your head and/or when your patients need real surgical management of MSK issues of the foot/ankle as well as all other surgical MSK needs.... above mid-shaft tib/fib of course since we all know that beyond that DPMs have no business.

Cheers

SD

Wait for it........ wait for it.........and.... cue Kidsfeet attempt to retaliate.....

lol, you probably can't even name all the bones in the foot from memory.

You want to talk about who's smarter? I'm not even ortho, but here goes.....Podiatry = bottom of premed class. Ortho = top of med school class. This is the reason you were left with feet to manage. It's the only thing simple enough for you to wrap that small, insecure brain around. Cheers!

Originally Posted by ScootDoc

Yeah, yeah. Enjoy yourself with all those diabetic foot ulcers my friend. I'm sure they'll make for a very fulfilling career... Give Ortho a call when you get in over your head and/or when your patients need real surgical management of MSK issues of the foot/ankle as well as all other surgical MSK needs.... above mid-shaft tib/fib of course since we all know that beyond that DPMs have no business.

Cheers

SD

Wait for it........ wait for it.........and.... cue Kidsfeet attempt to retaliate.....

"Enjoy yourself with all those diabetic foot ulcers my friend. I'm sure they'll make for a very fulfilling career"

I fully intend to. With 135 million diabetics by 2020, you would be an idiot not to treat this population.


"Give Ortho a call when you get in over your head and/or when your patients need real surgical management of MSK issues of the foot/ankle as well as all other surgical MSK needs.... ."


Ortho (without F/A Fellowship) are experts on F/A conditions/management? From Dr. Michael Pinzur
http://www.ncbi.nlm.nih.gov/pubmed/12921364

"above mid-shaft tib/fib of course since we all know that beyond that DPMs have no business"

No argument here, as I am being trained to be an expert from the Tib. tub. down...
There are more than enough cases to go around. Only on SDN do these degree pissing matches happen...here's an idea, maybe we should cut back on the chest thumping just a hair? Have a great day!

Originally Posted by mtwop

You want to talk about who's smarter? I'm not even ortho, but here goes.....Podiatry = bottom of premed class. Ortho = top of med school class. This is the reason you were left with feet to manage. It's the only thing simple enough for you to wrap that small, insecure brain around. Cheers!

"Podiatry = bottom of premed class. "

Here's where assumptions are problematic, do you have the stats of every applicant to Podiatry school? Do you really know what our grades/MCATs are? Did it ever occur to you that some of us might have chosen Podiatry because we enjoy the work? For me, I chose Pod over Med b/c I didn't want to go through 4 years of med school and end up in a non-surgical field...Also, what is meant by 'bottom of the barrel'? Quite a few of the Pod programs (Western/DMU/AZPOD) are affiliated with D.O. programs where the students sit in the same classes and take the same tests as the D.O. students. Please elaborate on 'bottom of the class'.

"This is the reason you were left with feet to manage. It's the only thing simple enough for you to wrap that small, insecure brain around."

And this is where you belittle every Podiatrist/ F/A Orthopod in the U.S. that have chosen to make the 'simple foot' their career choice... You're really on a roll here chief!

I'm not really sure that we're the insecure ones here...'Cheers!!'

Man, has this place gone down the sh!tter.

This drama has it's own thread, please take the podiatry trolling there: http://forums.studentdoctor.net/showthread.php?t=895803.

Originally Posted by mtwop

You want to talk about who's smarter? I'm not even ortho, but here goes.....Podiatry = bottom of premed class. Ortho = top of med school class. This is the reason you were left with feet to manage. It's the only thing simple enough for you to wrap that small, insecure brain around. Cheers!

Your premise is flawed, so I'm probably smarter. You implied that I said that pods were smarter than orthopods. Not only would it be a waste of time to try and compare, but I never suggested it at all.

I was merely suggesting that pods focus on the feet and are the experts of the foot. Orthos can keep your spin, shoulder, hands, arms, etc etc, but pods will continue to be the specialists of the foot and ankle. My comment was simply to illustrate the complex nature of the f/a and that to truly master the f/a msk, you must devote your career to it.

What am I insecure about? Nothing, I am going to be a specialist of one of the most complex parts of the body.

Let me leave you with some words from some random guy in history you may have heard of - Da Vinci, "The human foot is a work of art and a masterpiece of engineering.”

Originally Posted by KinasePro

Man, has this place gone down the sh!tter.

This drama has it's own thread, please take the podiatry trolling there: http://forums.studentdoctor.net/showthread.php?t=895803.

But there's no fighting thereeeeeeee

Come on guys! You're better than this.

We are all professionals.

Originally Posted by JackShephard MD

Come on guys! You're better than this.

We are all professionals.

Originally Posted by MaxillofacialMN

lol, you probably can't even name all the bones in the foot from memory.

Laughable, consider yourself ignored due simply to the fact that you are a PRE-Podiatry student. The fact that you have never in your life even looked at a patient in a clinical setting let alone cared for one is flat out, undeniably laughable and discredits anything you say. Not only can I name them, but I know how to care for each and every one of them and there respective pathology. Which a far cry from what you can do... You will soon find out how much you don't know. Everybody does... yes everybody... ME included.

Originally Posted by ScootDoc

Laughable, consider yourself ignored due simply to the fact that you are a PRE-Podiatry student. The fact that you have never in your life even looked at a patient in a clinical setting let alone cared for one is flat out, undeniably laughable and discredits anything you say. Not only can I name them, but I know how to care for each and every one of them and there respective pathology. Which a far cry from what you can do... You will soon find out how much you don't know. Everybody does... yes everybody... ME included.

That's a lot words for someone who you are ignoring!

Originally Posted by ScootDoc

Laughable, consider yourself ignored due simply to the fact that you are a PRE-Podiatry student. The fact that you have never in your life even looked at a patient in a clinical setting let alone cared for one is flat out, undeniably laughable and discredits anything you say. Not only can I name them, but I know how to care for each and every one of them and there respective pathology. Which a far cry from what you can do... You will soon find out how much you don't know. Everybody does... yes everybody... ME included.

26M? 1st year resident? Laughable, consider yourself ignored due to the fact you couldn't get into allopathic school, tried for Caribbean, and now you think you run the world as a first year resident. Goooood oneeeeeee.

Originally Posted by MaxillofacialMN

26M? 1st year resident? Laughable, consider yourself ignored due to the fact you couldn't get into allopathic school, tried for Caribbean, and now you think you run the world as a first year resident. Goooood oneeeeeee.

Check again scooby! Allopathic, in the states, graduate, but nice try. Still, a hell of a lot further than you 1st year resident or not. BOOM!

Originally Posted by mtwop

You want to talk about who's smarter? I'm not even ortho, but here goes.....Podiatry = bottom of premed class. Ortho = top of med school class. This is the reason you were left with feet to manage. It's the only thing simple enough for you to wrap that small, insecure brain around. Cheers!

First of all, I am sorry to intrude in your forum....but this comment is blatantly false. I understand you may be speaking from knowledge regarding some Podiatry students, but there is no need to bash us all. As with any profession there is a great spectrum of individuals and by no means should you measure a profession by the individuals that are at the tail end of the curve.

I for one was well above average when it came to all the traditional pre-medical statistics. It just so happens I choose to receive a podiatric medical education instead of jumping the proverbial hurdles to become a F/A ortho.

Please take the advise of your colleague and act professional.

I'd say the drawbacks of Orthopedic Surgery are uncontrollable work hours. When a case needs to get done, you're going to stay until its done.

This thread makes both orthopods and podiatrists look like utter f'tards.