Yes. Especially in trauma you are dealing with patients who have bloodborne illnesses, particularly in iv drug users. I generally assume everyone has hiv and hep c unless proven otherwise.
So there are a few points about this. Safety obviously is the first step, and knowledge is the best kind of safety. Know where the fracture fragments are—don’t stick hands where you can’t see. Don’t use double ended K wires. Always look at what your scrub is handing you, and what you are reaching for. Complacency is the enemy— if you stop paying attention, that is when you can get hurt. As Mad-Eye Moody said, “constant vigilance!”
There are also techniques we use to minimize potential injury. We don’t plunge with drills, we complete cuts using osteotomes instead of saws, etc. But even then, it’s always a risk. Especially if you’re not the one operating and the resident f—s something up. So you have to watch them as well. A surgeon in a hospital I worked in had an intern put a drill straight through his hand, like all the way through the palm a la Jesus on the cross. Patient had HIV. Surgeon was on antiretrovirals for months. That’s why I don’t let anyone operate unless I know they are careful. And even then, if I see them doing something that could potentially go wrong 3 steps ahead, I correct right then, or take over.
I’ve been injured multiple times —been stabbed by a careless attending with a hep C needle, by a scrub with a double ended K wire that was accidentally placed in the tray, and I’ve stabbed or poked myself with fracture fragments and needles. I’ve also inadvertently injured others when I was a resident. Double gloving takes care of minor things—if it gets both gloves, most of the blood is left on the glove and very little goes into your hand. But yes, it’s obviously worrying and I usually have the patient tested... a few times (when the patient had untreated hep C with high viral load) i have had myself tested for 6 months to ensure I didn’t get it. And during that time, I used condoms (protecting my husband) and didn’t donate blood just in case. (I also routinely take a hep c test yearly to make sure that I didn’t get infected from a poke or eye splash I didn’t notice, but I’m very OCD, and that’s probably unnecessary.) It’s stressful, but it’s a risk every surgeon must be prepared to take. Sometimes you must put your hands somewhere on a fracture that’s not super safe to get a good reduction. So you just have to be very careful and stay out of your instruments’ way.
And failing all that, I have several million dollars’ worth of hospital-based AND separate private disability insurance that I pay up the arse for. My hands and my eyes are my life, so I make sure if I cannot work, I’m more than covered, and can sit on my butt in my house in the South Caribbean for the rest of my life writing textbook chapters and drinking mojitos.
I'm currently in a situation where I could attend a reputable MD school that is connected with 2 ortho residencies, or I could attend a newer MD school that doesn't have much of a reputation nor connections to any ortho residencies. The only reason I'm considering the latter school is because my husband lives in the same city as that school, and if I go to the first school I'll be living ~1,000 miles from my husband for 2 years or so. Do you think where someone attends medical school (with concern to the school's reputation) is an important factor with matching to an orthopedic residency? Similarly, are medical schools that have an affiliated ortho residencies significantly better for helping students match to those ortho residencies? Thanks!
