Hand surgery

[hm239]

hey guys,
i'm interested in hand surgery and i'd like to get your input on ortho vs. plastic. what are differences in the cases they see? can you do microsurgery/flaps as ortho surgeon? or any other thoughts before deciding between the two specialties to go for hands-
thx

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[ORS]

Right now, you have to decide if you like plasticsor ortho more. You can do a hand fellowship and then do flaps, replants, etc from either. My spin is from orthopaedics, so I am biased.

Plastic surgery is a specialty that shares multiple areas with other specialties (hand with ortho, face with ENT, etc).

In most residencies you will be a better rounded physician with plastics, but you have to decide if that is what you want. That was not for me, thus I am in ortho.....

 

[droliver]

If you know you want to do hand surgery, you're usually waaaaay better off from the orthopedic background then from Plastics. When you consider the upper limb as a whole shoulder to fingers, you just don't get the exposure to arthroscopy, PT, elbow/wrist mechanics, etc... that go along with being a complete upper limb surgeon from a one year hand fellowship.

While a plastic surgeon is likely going to run rings around you as a resident in microsurgery, most things in practice don't involve replants, free flaps, and toe to hand transfers.

 

[maxheadroom]

Both are good routes to Hand. I'm in Plastics and I'm going on to do a Hand fellowship next year. It mostly depends upon which other parts of the specialties you like more. I was torn between Ortho and Plastics, but realized that I much preferred Breast and Facial Aesthetics compared to total joints. If you want to be a pure upper extremity surgeon, you're better off in Ortho for the reasons that Ollie mentioned, plus the shorter duration in training. The big thing is to figure out what other things light your fire.

 

[srs1234]

Is there a difference between the abillities of a plastics-hand trained and an ortho-hand trained surgeon in the ability to perform microvascular, replants, etc.... assuming one can land a comprehensive type fellowship?


along the same vein... is it possible to do a "ue/hand" fellowship that also encompases brachial plexus cases? I scrubbed a brachial plexus neurolysis with a neurosurgeon and loved it (it was my favorite thing I did the entire month)

I am torn between plastics and ortho...as there are things I love from both fields.

 

[pagemmapants]

I was in sort of the same place a while back - I had a great experience on both my ortho and plastics elective rotations and was trying to figure out which would be more "right".

What it came down to for me was the "bread and butter" procedures. Yeah, okay, enormous flap recons and toe-to-thumb txfers and hand replants and that sort of thing are awesome and you can get to those from either field. But there's going to be a lot of time in your training and likely in your practice where you're going to be doing the less awesome smaller whacks. Would you rather be sucking fat or banging in tibial nails?

Edit: Much like what maxheadroom said (more eloquently) above.

 

[orthodoctfemur]

I am interested in hand also and have the same dilemna: ortho or plastics. Does one of these routes give you more overall hand experience when it is all said and done? Do ortho and plastics hands ever work together in practice? Thanks

 

[VincentAdultman]

I am interested in hand also and have the same dilemna: ortho or plastics. Does one of these routes give you more overall hand experience when it is all said and done? Do ortho and plastics hands ever work together in practice? Thanks

You can probably do similar things going both routes.

I tend to believe that the decsion should be based on what you like about the specialties outside of hand surgery. Keep in mind that a large amount of residency will be spent doing things other than hand surgery. If total joints, IM nails, and knee scopes aren't your thing then you probably are going to be in for a long five years if you choose ortho.

BTW If you go plastics whether that's via fellowship or an integrated residency that's at least twice the general surgery you'll be doing as well.

 

[RadOncDoc21]

General Surgery route is another option... although not typical, I know of 3 general surgery residents who did hand fellowships. Although I personally would go plastic route if I had to choose one.

-R