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Hello doc. I am orthopedician from outside us/Canada. I want to do fellowship in us. How competitive is it? And are we allowed to practice in us after fellowship in USA? Having a greencard. And please elaborate the requirements

Depending on what you want to do, some fellowships are more competitive than others. You can't practice in the US with just a fellowship. You need residency and board certification or eligibility. Please consult the AAOS website for specifics as every fellowship is different.

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It is very applicant dependent, but these days I think a score less than 230 would be difficult for the match.
Thanks! It’s always hard to tell, people will say that obviously 250+ is ideal (“you’re golden!”) and <230 (“youre screwed!”) but nobody really talks about the 240s which made me afraid that 240s made me secretly ineligible. Like the emperor with invisible clothes and everyone was too embarrassed to tell me.
 
Thanks! It’s always hard to tell, people will say that obviously 250+ is ideal (“you’re golden!”) and <230 (“youre screwed!”) but nobody really talks about the 240s which made me afraid that 240s made me secretly ineligible. Like the emperor with invisible clothes and everyone was too embarrassed to tell me.

240s is a fine score. Not as good as it used to be but still pretty good.

60% of applicants with a score between 221 and 230 matched in 2016. Obviously you have no idea of what other variables there are with an application (research, clinical grades, LORs) but I think it's a stretch to say you're screwed if you score below 230.

Having said that, the tables get REAL ugly quickly once you start getting below 220.
 
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240s is a fine score. Not as good as it used to be but still pretty good.

60% of applicants with a score between 221 and 230 matched in 2016. Obviously you have no idea of what other variables there are with an application (research, clinical grades, LORs) but I think it's a stretch to say you're screwed if you score below 230.

Having said that, the tables get REAL ugly quickly once you start getting below 220.

I wouldn't say you are screwed with a 230, but the average score of the applicants I see is 245. Just saying.
 
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Probably a bit early to be asking this but hoping to plan my schedule early: If I got an above average Step 1 score for ortho (250), should I delay taking Step 2 until after applications are due? I heard that a poorer performance on Step 2 CK can detract from a high score on Step 1.
 
Probably a bit early to be asking this but hoping to plan my schedule early: If I got an above average Step 1 score for ortho (250), should I delay taking Step 2 until after applications are due? I heard that a poorer performance on Step 2 CK can detract from a high score on Step 1.

I think the first step is getting a step 1 score that keeps ortho on the table is the thing to focus on right now.
 
I think the first step is getting a step 1 score that keeps ortho on the table is the thing to focus on right now.
Did you read my post? I got 250 for step 1. Hopefully its still on the table.
 
Did you read my post? I got 250 for step 1. Hopefully its still on the table.
Oh my bad, I thought you meant "if i get a 250"

From the peeps applying ortho in my school it seems that <260 took step 2 before apps, 260+ after.
 
Oh my bad, I thought you meant "if i get a 250"

From the peeps applying ortho in my school it seems that <260 took step 2 before apps, 260+ after.
Thanks! My bad for the ambiguity.
 
Probably a bit early to be asking this but hoping to plan my schedule early: If I got an above average Step 1 score for ortho (250), should I delay taking Step 2 until after applications are due? I heard that a poorer performance on Step 2 CK can detract from a high score on Step 1.

My program director says most programs still don't care about step 2 even if you crush it but it can hurt if you bomb it. This is consistent with 2016 program director survey where 98% of programs cite step 1 at a rating of 4.5 for determining who gets interviewed and only 67% cite step 2 at 4.0 rating. And for ranking applicants the difference is the same when looking at step 1 vs step 2.

However, step 1 only get your foot in the door. You gotta have a likable personality, interview well, and do well on aways along with other things.


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It kind of sucks but 250 is not as impressive as it used to be for orthopedics. It is an amazing score, but the average was 247 in 2016, up from 245 in 2014, and since the 2017 cycle was supposedly the most competitive to date, I'm thinking the average will hit 250 by 2018. Two PDs have told me you need equally good grades to match nowadays as well as very good performance on aways.

Yes, but we have accepted applicants with scores far below that. So don't be discouraged if you didn't get a 250. @TexasMeds, I think your performance on step two will be equally fine, and we do like to see those scores, even if we don't care that much about them. I would just take it and get it over with.
 
@OrthoTraumaMD How much does class rank/preclinical grades matter? For instance, is being in the third quartile a big negative even if the step scores/research/clinical grades are up to par?
 
Yes, but we have accepted applicants with scores far below that. So don't be discouraged if you didn't get a 250. @TexasMeds, I think your performance on step two will be equally fine, and we do like to see those scores, even if we don't care that much about them. I would just take it and get it over with.

Along same lines, If an applicant has step 1 - 249 and step 2 - 248. Would you prefer to see that rather than no step 2 score? Or should they just withhold score and release later in the season?


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@OrthoTraumaMD How much does class rank/preclinical grades matter? For instance, is being in the third quartile a big negative even if the step scores/research/clinical grades are up to par?

Class rank doesn't seem to be an issue as not everyone reports that, at least not that I've seen. We pay much more attention to step 1 and clinical grades.
 
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Depending on what you want to do, some fellowships are more competitive than others. You can't practice in the US with just a fellowship. You need residency and board certification or eligibility. Please consult the AAOS website for specifics as every fellowship is different.
What is the deal about the non accredited fellowship which accepts foreign docs without usmle? are the recruitee allowed to scrub and assist in the surgery? and is it regarded as a fellowship even though not allowed to word in the states and have to return back?
 
What is the deal about the non accredited fellowship which accepts foreign docs without usmle? are the recruitee allowed to scrub and assist in the surgery? and is it regarded as a fellowship even though not allowed to word in the states and have to return back?

It is usually used as a way for these foreign doctors to stay in the United States for a while and to gain cred in their home countries. They are not allowed to work in the states, but they sometimes use these fellowships as a path toward getting into residency in the United States. They are allowed to scrub and assist depending on the type of fellowship. Spine does this a lot.
 
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It is usually used as a way for these foreign doctors to stay in the United States for a while and to gain cred in their home countries. They are not allowed to work in the states, but they sometimes use these fellowships as a path toward getting into residency in the United States. They are allowed to scrub and assist depending on the type of fellowship. Spine does this a lot.
I have been called for an interview for non accredited fellowship. i have a residency degree from outside usa. what about the hand fellowship? I am confused . will this help me if i later try to apply for residency here?
 
I have been called for an interview for non accredited fellowship. i have a residency degree from outside usa. what about the hand fellowship? I am confused . will this help me if i later try to apply for residency here?
It could, but you need to meet the other requirements, and it is very program dependent. I would reach out to the program director with these questions.
 
Thank you very much for this thread. How are my chances of matching? What weaknesses should I remedy and how?

top 40 MD school
Preclinical grades: Pass (P/F curriculum)
Step 1: 242-245
Step 2: pending
Clinical grades: HP in psych, no other grades as of now
Research: 1 clinical database study with me as first author that is on track to be published, presented at 2 med school research conferences and at AMA national meeting, applying to present at AAOS and North American Spine Society meetings
Location: Willing to go to any state for residency. I would prefer an academic program over a community program but I am flexible in this. Do not care about program ranking.

I'm am fully prepared to take a research year. One of the attendings at my school has been a leader in his subspecialty for > 20 yrs and many students at my school have done a productive research year with him and subsequently matched. How much would I benefit from a research year? How necessary is it for me?

In my very first post, I stated that I would not be answering individual "what are my chances" questions due to the variability of applicants.
 
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@OrthoTraumaMD Thank you for doing this. I'm an M3 now and have two years of research in plastics - what drew me to the field was the creativity of the reconstruction procedures and the satisfying idea of using a patient's own tissue in an ingenious way to create new functions. The more I learn about ortho - the more I realize that there are many aspects in it that would satisfy that interest for me. Can you comment on whether there is a good amount of creativity needed for ortho? Do you think that you could have liked the recon aspects of plastics if you had to do it over? (PS: another thing is that I think I would much rather be doing joint replacements than facelifts when not doing recon surgery, if I had the choice).
 
@OrthoTraumaMD Thank you for doing this. I'm an M3 now and have two years of research in plastics - what drew me to the field was the creativity of the reconstruction procedures and the satisfying idea of using a patient's own tissue in an ingenious way to create new functions. The more I learn about ortho - the more I realize that there are many aspects in it that would satisfy that interest for me. Can you comment on whether there is a good amount of creativity needed for ortho? Do you think that you could have liked the recon aspects of plastics if you had to do it over? (PS: another thing is that I think I would much rather be doing joint replacements than facelifts when not doing recon surgery, if I had the choice).

I think plastics is fascinating, but I find the fine work required (nerves, vessels for flaps, etc) too delicate and painstaking for my liking. I think orthopaedic surgery does require creativity, but some subspecialties need it more than others. Tumor and trauma come to mind as there are many different ways to fix a fracture or deal with a lesion (you haven't lived until you've seen a hemipelvectomy), and it is very patient dependent. Part of what drew me to trauma was the chance to think about the approach to each fracture, and to do things elegantly and not "by rote" as in joint replacements. Ultimately, I think you just need to rotate in both and see which appeals to you "at its worst." Take the things about the specialty that you like the least and imagine yourself doing that-- whichever one still appeals to you despite the "worst" parts, that is the one you should choose.
 
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awesome thread...I am currently a medical student with an interest in surgery..particularly looking into ENT-facial plastics or urology. I tried ortho but the subject matter just didn't do it for me but much respect to those who do it...definitely a great field and you help a ton of people.

I thought I'd ask your thoughts on ENT and urology from what you know and maybe saw in residency, etc. Lifestyles, incomes, demand compared to ortho? How do orthopods view other surgical subspecialties, including these? Any insight would be great. Thanks again.
 
awesome thread...I am currently a medical student with an interest in surgery..particularly looking into ENT-facial plastics or urology. I tried ortho but the subject matter just didn't do it for me but much respect to those who do it...definitely a great field and you help a ton of people.

I thought I'd ask your thoughts on ENT and urology from what you know and maybe saw in residency, etc. Lifestyles, incomes, demand compared to ortho? How do orthopods view other surgical subspecialties, including these? Any insight would be great. Thanks again.

We like our ENT and urology colleagues. The lifestyle seems better for urology, there are lots of outpatient procedures and the inpatient burden isn't as bad. ENT can be demanding but I don't know much about it otherwise, to be honest. Ultimately, I don't think you should care about what we (or really, anyone else) thinks of your chosen specialty. If you like it, go for it :)
 
Know anyone who's made the ortho -> neurosurgery switch?
 
It's hard for me to imagine anyone who would voluntarily make that decision.:)
No. That sounds like a terrible idea, haha!

Meh, I've already applied ortho and I love ortho. Just on an away right now and got slaughtered on a 30hr call with a junior.

Was jelly of the NS who was in the ED for like 20 mins the whole night while we go beaten up with pelvises, traction pins, finger injuries, etc. And then the NS got to do a crash crani.


...so yeah, NS call just seems kinda nice. you look at head CTs, get some sleep, and tell nurses to bolus 3% saline or do a neuro check. And when you're not doing that you get to saw a skull open.
 
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Meh, I've already applied ortho and I love ortho. Just on an away right now and got slaughtered on a 30hr call with a junior.

Was jelly of the NS who was in the ED for like 20 mins the whole night while we go beaten up with pelvises, traction pins, finger injuries, etc. And then the NS got to do a crash crani.


...so yeah, NS call just seems kinda nice. you look at head CTs, get some sleep, and tell nurses to bolus 3% saline or do a neuro check. And when you're not doing that you get to saw a skull open.
I’m only an ms1 but pretty sure ortho is the best bet if you’re trying to compare workload or hours. yeah sawing skulls open is pretty dope but I hope you don’t enjoy doing anything else
 
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Was jelly of the NS who was in the ED for like 20 mins the whole night while we go beaten up with pelvises, traction pins, finger injuries, etc. And then the NS got to do a crash crani.


...so yeah, NS call just seems kinda nice. you look at head CTs, get some sleep, and tell nurses to bolus 3% saline or do a neuro check. And when you're not doing that you get to saw a skull open.

This couldn't be farther from the truth, at least at my institution. The neurosurg residents are routinely the busiest ones overnight. I like to complain as much as the next guy, but my average call night is much more pleasant than it is for those guys. I don't envy them one bit.

That being said, I'd also take a traction pin or a reduction over a crani any day. Guess that means I picked the right specialty at least
 
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This couldn't be farther from the truth, at least at my institution. The neurosurg residents are routinely the busiest ones overnight. I like to complain as much as the next guy, but my average call night is much more pleasant than it is for those guys. I don't envy them one bit.

That being said, I'd also take a traction pin or a reduction over a crani any day. Guess that means I picked the right specialty at least

traction pin over a crani.... can't fix you
 
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Any thoughts on vascular surgery based on your interactions with that group as well as doing dual surgeries in trauma cases? Saw a few of those during my 3rd year rotations and thought they were interesting. Also how often are you consulting vascular surgery for arterial/venous damage caused by some ortho operations?
 
Haha, no way. Brains are for zombies.
Additionally, I don't want to get called for every old lady minuscule head bleed on a CT. If I'm woken up, at least it's for a decent reason...

Ya that's my only qualm with ortho. You get woken up for a finger lac the ED provider can't handle or a pussed out joint in a druggie.

Neurosurg can wake up to scroll thru a head CT, make sure the patient can wiggle their toes, and if they come in it's for a crani, burr hole. Plus you do still get acute fracture care of depressed skull fractures
 
Ya that's my only qualm with ortho. You get woken up for a finger lac the ED provider can't handle or a pussed out joint in a druggie.

Neurosurg can wake up to scroll thru a head CT, make sure the patient can wiggle their toes, and if they come in it's for a crani, burr hole. Plus you do still get acute fracture care of depressed skull fractures

Yeah, that's fair. More often than not though, we don't to come in for the finger lacs and such. The ER docs are just looking for some support and TLC.
 
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I have my first ortho rotation coming up soon. Any suggestions on materials/apps to use to really build a solid foundation of knowledge? Hopefully one that will carry over into my aways during 4th year.
 
I have my first ortho rotation coming up soon. Any suggestions on materials/apps to use to really build a solid foundation of knowledge? Hopefully one that will carry over into my aways during 4th year.

I answered this earlier in the thread... but I'd suggest Hoppenfeld Physical Examination of Spine and Extremities, Hoppenfeld's Surgical Approaches, Radin's "practical biomechanics for the orthopaedic surgeon," and Orthobullets.
 
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What has been the most difficult trauma case of your career thus far?
 
What has been the most difficult trauma case of your career thus far?

I can't really pick one. Some were difficult due to patient morbid obesity, others difficult due to fracture morphology. The most convoluted had to be a really dusted pilon in a young person where the joint was in a million pieces and I spent way too much time trying to reconstruct it, reducing one piece tended to malreduce another, etc. He did well though, or as well as those tend to do.
 
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I can't really pick one. Some were difficult due to patient morbid obesity, others difficult due to fracture morphology. The most convoluted had to be a really dusted pilon in a young person where the joint was in a million pieces and I spent way too much time trying to reconstruct it, reducing one piece tended to malreduce another, etc. He did well though, or as well as those tend to do.
How do you even go about fixing comminuted fractures like the one you mentioned? When I picked up on Total Joint one week I had a patient with a comminuted tibial plateau fracture that look like a grenade went off inside his knee when I looked at his radiograph. I kept wondering how the surgeon even goes about putting all of the hundreds of pieces back together.
 
How do you even go about fixing comminuted fractures like the one you mentioned? When I picked up on Total Joint one week I had a patient with a comminuted tibial plateau fracture that look like a grenade went off inside his knee when I looked at his radiograph. I kept wondering how the surgeon even goes about putting all of the hundreds of pieces back together.

Shake the patients hand, "welcome to arthritis"
 
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Shake the patients hand, "welcome to arthritis"
Actually Honkonen showed us long ago that the risk of arthritis after a tibial plateau fracture is around 40%, and most of it is mild and clinically inconsequential. It is meniscal injury that is the best predictor of bad arthritis, which is why you repair the meniscus in these cases.
Now as for spine... You just get adjacent disc degeneration and keep operating and operating.... ;)
 
How do you even go about fixing comminuted fractures like the one you mentioned? When I picked up on Total Joint one week I had a patient with a comminuted tibial plateau fracture that look like a grenade went off inside his knee when I looked at his radiograph. I kept wondering how the surgeon even goes about putting all of the hundreds of pieces back together.

Fractures occur in patterns, and the presence of comminution doesn't necessarily doom the patient to a clinically bad result. In normal ankles for example, most of the load is anterior, so posterior comminution isn't clinically significant provided you achieve stability and address the major pattern. Certainly, malreduction matters in some joints more than others--the acetabulum, for example, cannot take more than 1-2mm of step-off. But for the most part, provided you understand the biomechanics, you don't have to put all the pieces back anatomically--just the important ones.
 
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Fractures occur in patterns, and the presence of comminution doesn't necessarily doom the patient to a clinically bad result. In normal ankles for example, most of the load is anterior, so posterior comminution isn't clinically significant provided you achieve stability and address the major pattern. Certainly, malreduction matters in some joints more than others--the acetabulum, for example, cannot take more than 1-2mm of step-off. But for the most part, provided you understand the biomechanics, you don't have to put all the pieces back anatomically--just the important ones.

So what happens to the clinically insignificant fragments? Do you rinse them out? Are they absorbed or broken down by the body? I am just curious because it seems like leaving fragments behind at their now non native site would lead to chronic inflammation issues. Or am I way off?

Thank you for all of your replies. They are so helpful and educational.
 
So what happens to the clinically insignificant fragments? Do you rinse them out? Are they absorbed or broken down by the body? I am just curious because it seems like leaving fragments behind at their now non native site would lead to chronic inflammation issues. Or am I way off?

Thank you for all of your replies. They are so helpful and educational.

You take them out if they are in a joint space and could potentially become loose bodies, or if they are completely devascularized and could become a nidus for infection (as in an open fracture). Otherwise, you keep them in there and they incorporate into the healing process.
 
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My apologies in advance if my question seems somewhat dumb/offensive.

If a student is doing his/her away rotations and is the perfect student (excellent boards, hardworking, eager to learn, polite, well-liked by everyone etc), wouldn't the attendings be not inclined to write a nice LOR for that student? Writing a super good letter seems to run counter to the interest of the attending if a program highly desires a particular student to become their resident. I'm sure no one would sabotage us by writing a horrible letter, but writing an excellent letter for a highly desired student seems counter-productive as that student might get "snatched" by another program.
 
My apologies in advance if my question seems somewhat dumb/offensive.

If a student is doing his/her away rotations and is the perfect student (excellent boards, hardworking, eager to learn, polite, well-liked by everyone etc), wouldn't the attendings be not inclined to write a nice LOR for that student? Writing a super good letter seems to run counter to the interest of the attending if a program highly desires a particular student to become their resident. I'm sure no one would sabotage us by writing a horrible letter, but writing an excellent letter for a highly desired student seems counter-productive as that student might get "snatched" by another program.

... well if a student is doing an away someplace - that place is probably pretty high on their list since they are spending money to go someplace, live there, and check out the program.

At least that was how it was for me. My aways were 1) super balanced program with strength in all subspecialties and trauma in an awesome place to live. 2) as before, but larger and more urban, 3) close to family, good program but weaker in a few subspecialties it seemed like.
 
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