These people are pretty skilled as far as taking any trauma that comes in right? As much of these jobs are rural I feel like you most be competent in a lot of rearfoot/ankle trauma pathology.
I’d feel terrible having to try to fix a calc fx or pilon. personally
You will quickly realize the is a MASSIVE difference between
low and high energy trauma... just cracked vs highly committed/displaced. The skill/planning level and outcomes are night and day.
There are two limit points:
surgeon's skill and facility/staff capabilities. A lot of the podunk hospitals or boondocks IHS and many CAHs simply don't reliably have the staff to help with those distractions and maybe ex fix and all the moving parts required on those cases. Some do. Sometimes, a good scrub tech quits and you're in rough shape for awhile. Sure, you can use push-pull fibula or distractors or tell the big circulate nurse guy to scrub in for 5min to help distract, but
you are only as good as the overall team. Some things you can do in a metro hospital with a resident or two and an ortho scrub tech or two simply
aren't done well in rural with just you and one or two techs who do mostly OB and gen surg. (found this out a few times in my own career!)
This mindset also applies to recon ... huge diff between in situ and
realignment fusions (flatfoot, cavus, charcot, post trauma, TAR/fusion, etc). A flexible flatfoot is not too tough; a rigid one realignment is a major undertaking. Just because someone did a few Charcot planing or a handful of SER-2 in residency does NOT mean they "know Charcot recon" or "know ankle fractures."