Hands: Ortho v. Plastics

[pagemmapants]

I posted a similar question in the Plastics forum, but I hope they don't get me for "cross posting" since there are people that only look at one or the other! 🙄

Anyway, I'm very interested in hand surgery, particularly the increasing practice of hand transplantation via microsurgical techniques.
But just generally speaking, is it better to approach hands via orthopedics or via plastics? I know that most hand surgeons are currently boarded in ortho, but are there separate hand fellowships for plastics versus ortho? Or do both lead into the same fellowships?
In the interest of full disclosure I'm a 5'2" female with a pretty sad bench press (relatively speaking) so I'm a little apprehensive about pursuing a career in the locker room. (Semi-joking - is it really that bad?)
Thoughts?

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[PediBoneDoc]

hand surgery is dominated by ortho from the stand point of the american society for surgery of the hand. that being said, in going into ortho or plastics for hand you have to understand their basic roots.

ortho does bones, tend to be more focused on boney and tendon work

plastic does softissue, more facile with flaps.

you have to look at what type of practice you want. if you want a flap practice (free and rotational flaps) do plastics. if you like boney work, do ortho.

in the end you will be able to do the same thing.

on another note, if you are at Duke, look up dr. patel (peds ortho) she can help you in your decision.

 

[moquito_17]

I sat next to Dr. Patel at a session at AAOS in San Diego this year. She is very pleasant. I reccomend to the original poster (OP) to approach her.

As an orthopaedic surgeon, I have my bias that you ought to do ortho to do hand. A lot of hand surgery is bone, tendon, ligament etc work and ortho prepares you for that. Plastics is 5+2 years of buts guts, flaps and boobs, THEN a hand fellowship to get you there. You still never have the same boney understanding that we have been getting ponded on every year on the OITE.

Also, the difference between PS-hand and Ortho-hand is good when it comes to combined cases. We do arm/forearm/wrist frx all the time, while PS doesn't do that. Occasioanlly, I have been called when PS is on hand call for a combined hand plus arm/forearm/wrist that needs ortho. If were were on Hand Call that nite we would have taken it all. Stupid stuff, but worth mentioning.

Do what you want, but at the very least, call Patel.

Best of luck to you,

 

[pagemmapants]

Thanks for all the info: I think I will certainly get in touch with Dr. Patel if she's as friendly and open as y'all say she is! Peds ortho sounds pretty awesome too, if hands doesn't keep me entertained.

Here's a question - I have a good friend whose Dad is an ortho-->hand guy. . . I approached him to ask him about the future of hand surgery, etc and he seemed to have GREAT concern about my chances of being able to have a life even approaching normal (husband, kids, etc). Is it really that bad nowadays? I'm rather hoping not, considering he went through residency about 35 years ago and I'm sure a number of things have changed since then, but is it a valid concern?

 

[dilated]

Hand can be brutal because of the trauma call and the length of some cases.

I crossed it off the list when a plastics attending started reminiscing over the 15-20 hour cases he did in residency. 20 hours of microsurgery. And apparently that's not terribly uncommon, I saw a bit of a replant case once that was supposed to take 12. 😱

At least you get to sit down...

 

[Tired]

hand surgery is dominated by ortho from the stand point of the american society for surgery of the hand. that being said, in going into ortho or plastics for hand you have to understand their basic roots.

Is the Ortho side doing microsurgery? I spent a month on hand this year, did a lot of carpal tunnels, tendon transfers, and UE trauma, but never saw any microsurgery and never thought to ask about it.

 

[pagemmapants]

I think I'm pretty sure Plastics does most of the microsurgery. Could be wrong, tho.

 

[PediBoneDoc]

Is the Ortho side doing microsurgery? I spent a month on hand this year, did a lot of carpal tunnels, tendon transfers, and UE trauma, but never saw any microsurgery and never thought to ask about it.

depends on where you train. some hand fellowships are heavy on the replant and flap (free fibular grafts). plastics by training have more exposure to microsurgery based on their residency training. so, i think in general plastics is better at micro surgery (don't let those 90210 docs know i said that ) but both do microsurgery.

i personally would not want to be on replant call, that just sucks. just my personal opinion.

 

[moquito_17]

depends on where you train. some hand fellowships are heavy on the replant and flap (free fibular grafts). plastics by training have more exposure to microsurgery based on their residency training. so, i think in general plastics is better at micro surgery (don't let those 90210 docs know i said that ) but both do microsurgery.

i personally would not want to be on replant call, that just sucks. just my personal opinion.

I agree that it is program-dependent. The ortho hand service where I am does a lot of microsurgery. They do brachial plexus surgery, replants, nerve repairs, etc.

 

[asdf123]

As one poster mentioned, the issue of being able to cover upper extremity injuries vs. hand only (distal to wrist) is an important one. As a plastic surgeon who sees combined injuries in upper extremity, you would need ortho help.

As far as lifestyle, it depends on the practice you choose, and how hard you want to work. REsidency is tough no matter what. After fellowship, YOU CHOOSE the type of practice you want. If you have 8 hand surgeons in your group, you're on call every 8th night or so...not so bad. But if you're the only hand surgeon in a 50 mile radius, you're screwed. You will have to take hand call no matter where you go, but if you live near a big hand center you can transfer the replants and complex cases.

Remember you may change your mind. Don't do plastics because you want to do hand...you may end up hating hand down the line (wait till you have to take care of nasty lacerations at 2 am on call). Decide between plastics and ortho based on the overall opportunities each offers.