Ortho Hand compared to Plastic Hand

[nickmx50]

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Hi there. I'm a pre-med who will be shadowing some plastic surgeons this september. I noticed they do a lot of hand surgery, which I thought was primarily done by Ortho Surgeons. I'm wondering what's the difference between the two? I apologize if this is the incorrect forum for this question. Thanks

 

[DoctaJay]

Just depends which hospital you are at. At my program, plastics and ortho split hand call 50/50, but I have a feeling that our orthopods do more hand here. Other places its the opposite. Many different fields overlaps with certain procedures. Ortho and Neurosurg overlaps with "some" spine cases.

 

[DHT]

Last I heard, Hand surgeons were 70/30% ortho/plastics. After the hand fellowship, I would say both will have very similar practices in what they can do. The big variable is what they WANT to do which makes them different. I would also say that both routes are equally qualified to do hand surgery.

Ortho: More experience with wrist and elbow arthroscopy and operative fixation of fractures.

Plastics: More experience with microvascular/flaps and burns.

Those differences are just for when GOING into fellowship and I would imagine that at the end you would round out your training in whatever you are weaker in.

The way I would decide on which way to go is by everything else the specialty has to offer. So look at what ortho and plastics do OTHER than hand and decide what you like better. Also, I see a fair amount of ortho hand go all the way up to the shoulder. I have never seen plastics go higher than the elbow (doesn't mean that it doesn't exist) so that may be one thing that may sway you.

 

[ddmo]

There are 4 ways to practice hand surgery

1) Ortho residency + 1 yr hand fellowship
2) Gen surg residency + Plastics fellowship + Hand fellowship
3) Plastics residency + hand fellowship
4) Gen surge residency + hand fellowship (rare)

The most common route is through an orthopaedic residency. It makes the most natural transition in my opinion (but im biased). I think the worst is the general surgery to hand fellowship. Those guys are using a drill for the first time during their fellowship and only then are learning the principles of osteosynthesis, which is not ideal.

 

[maxheadroom]

Last I heard, Hand surgeons were 70/30% ortho/plastics. After the hand fellowship, I would say both will have very similar practices in what they can do. The big variable is what they WANT to do which makes them different. I would also say that both routes are equally qualified to do hand surgery.

Ortho: More experience with wrist and elbow arthroscopy and operative fixation of fractures.

Plastics: More experience with microvascular/flaps and burns.

Those differences are just for when GOING into fellowship and I would imagine that at the end you would round out your training in whatever you are weaker in.

The way I would decide on which way to go is by everything else the specialty has to offer. So look at what ortho and plastics do OTHER than hand and decide what you like better. Also, I see a fair amount of ortho hand go all the way up to the shoulder. I have never seen plastics go higher than the elbow (doesn't mean that it doesn't exist) so that may be one thing that may sway you.

There's a big fallacious idea that Plastic Surgeons only do skin. With the exception of elbow scopes (which almost no Plastics/Hand surgeons do), all of the stuff that you attributed to Ortho Hand is a significant part of my Plastics/Hand practice. I do BBFFs, distal radius, intercarpal fusions, wrist scopes +/- arthroscopic TFCC debridements and repairs, and any other bony work that an OrthoHand guy does. I can do radial heads, but I send them to an Elbow guy that sends me Hand stuff.

 

[Therecanbeonlyo]

There's a big fallacious idea that Plastic Surgeons only do skin. With the exception of elbow scopes (which almost no Plastics/Hand surgeons do), all of the stuff that you attributed to Ortho Hand is a significant part of my Plastics/Hand practice. I do BBFFs, distal radius, intercarpal fusions, wrist scopes +/- arthroscopic TFCC debridements and repairs, and any other bony work that an OrthoHand guy does. I can do radial heads, but I send them to an Elbow guy that sends me Hand stuff.

This brings up the important point of it depends on 2 things, 1. your trainig, 2. you're comfort/what you want to do.

To do ortho hand you have to first do an entire ortho residency which means you have been previously trained on managing the entire upper extremity. Most ortho hand fellowships train upper extremity (or at least to the elbow). Some of the hand guys I've worked with do all the way up to the shoulder, some just do to the elbow. Conversely, the plastic hand guys i've worked with only do hand from the wrist down. But that is just at the hospital that I worked at and I think that just has to do with their comfort. The question comes down to elbows. Ortho guys definitely do them. Some plastics guys will, some wont (from what I've seen)

So, if you just want to do hand, you could do either. It would depend on what you want to do prior to your fellowship...whether you want to try for one of the plastic spots and do a plastic surgery residency, you want to do a gen surg residency followed by plastics followed by hand (seems long), or do ortho followed by hand.

Personally, I would do ortho first then hand (but i'm extremely bias 😀)

 

[maxheadroom]

So, if you just want to do hand, you could do either. It would depend on what you want to do prior to your fellowship...whether you want to try for one of the plastic spots and do a plastic surgery residency, you want to do a gen surg residency followed by plastics followed by hand (seems long), or do ortho followed by hand.

That's the deciding factor. I thought I was going to be an orthopod until I rotated on Ortho and scrubbed total hips, total knees, spine cases, and peds. Similarly, I scrubbed Plastics and saw breast surgery, facial recon, aesthetic surgery, and upper extremity stuff. Much more my speed.

And accredited Hand fellowship (doesn't matter Plastics or Ortho) should be their fellows enough exposure to the "Ortho Hand" stuff to be competent. The bigger issue is referral patterns. I don't get a lot of referrals for DRUJ problems because those are frequently internal referrals within an Ortho group. I don't do much distal radius because my plastics group doesn't take distal radius call and I just pick some up here and there from direct referrals to me.

 

[deleted745951]

Bump, Theres a huge discrepancy with the salary of a ortho-hand and a plastics-hand. Anyone here who could shed some light?

 

[deleted745951]

Sorry for the six year bump haha

 

[droliver]

If you know you want to be hand surgeon, you'd want the Orthopedics background ALL DAY LONG, particularly in most metro areas of any size. It is by far the better background for specializing in common hand/wrist/UE surgery and it's (generally speaking) a much easier background to find a job focused in that field. I think as a true Upper Extremity surgeon today, you need to be able to do shoulder and elbow procedures, which is not something a lot of plastic surgeons get, even in fellowship. Microsurgery is a small or nonexistent part of most high volume hand surgeons, with many orthopedists having never been trained in microsurgical reconstruction. Hand is an odd fit for Plastics in private practice, as you really need the whole infrastructure to do it well (in house x-rays, casting, & PT/OT) that usually only exists within an orthopedic group.

Now "Gentleman's Hand Surgery" (carpal tunnel, ulnar nerve transposition, and trigger fingers) is a little different in that you don't need the other staff and equipment in your clinic, but can be hard to get the cases in most areas. This high volume simple outpatient cases are what churn the wheel of big hand practices.