Name: 所以，你想成為一名外科醫生[Ep. 7]。 (So You Want to Be an ORTHOPEDIC SURGEON [Ep. 7])
Uploaded: 2021-01-14T11:04:02.000Z
Duration: 15 min 7 s
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So you want to be an orthopaedic surgeon. You like the idea of fixing broken bones and

bro-ing out. Let's debunk the public perception myths of what it means to be an orthopaedic

surgeon, and give it to you straight. This is the reality of orthopaedic surgery.

Welcome to our next installment in So You Want to Be. In this series, we highlight a

specific specialty within medicine, such as orthopaedic surgery, and help you decide if

it's a good fit for you. You can find the other specialties on our So You Want to Be

playlist. A lot of you asked for orthopaedic surgery in our poll, so that's what we're

covering here. If you want to vote in upcoming polls to decide what future specialties we

If you'd like to see what being an orthopaedic surgeon looks like, check out my second channel,

Kevin Jubbal, M.D., where I do a second series in parallel called a Day in the Life. We've

already covered two episodes on orthopaedic surgery, so check them out after this video.

show footage from Randy McKnight's and Daniel Choi's”`

Ortho, coming from Greek orthos, meaning “straight or to correct” and paideia, meaning “rearing

of children”, was originally concerned with treating children with skeletal deformities

like bow legs or knock knees. In essence, orthopaedic surgery focuses on the musculoskeletal

system. This translates to fractures, meaning broken bones, but also surgeries involving

tendons, ligaments, and sometimes nerve or vascular injuries.

The sports injuries you see on TV of your favorite athletes, like ACL tears, Achille's

ruptures, or rotator cuff issues are handled by orthopaedic surgeons. But there's much

There's a variety of ways to categorize orthopaedic surgery. You can look at interventions

that deal with fractures of bones versus soft tissue ligamentous and tendinous repair. You

can look at non-acute versus acute surgery, such as trauma. Outpatient versus inpatient.

Arthroscopic minimally invasive versus open surgeries. Adult versus pediatrics. Or regionally,

you can look at orthopaedic surgery as spine versus pelvis versus extremities.

To become an orthopaedic surgeon, you'll have to complete a 5-year orthopaedic surgery

residency after medical school. A single research year is generally optional and can be pursued

by those interested in becoming surgeon scientists.

In terms of competitiveness, orthopaedic surgery is consistently in the top five, in most recent

years being ranked fourth, only behind dermatology, plastic surgery, and neurosurgery.

To be considered at an orthopaedic surgery program, your Step 1 score and 1 rep max on

bench press must exceed 500, otherwise your application will be tossed out. I'm kidding

obviously, but only sort of. Orthopaedic surgery candidates are top students, with very high

Step 1 and Step 2 scores. The field is highly dominated by men, at approximately 95%, however

that's changing for the better, and I've worked with several talented female orthopaedic

Like all surgical residencies, orthopaedic surgery residency will be incredibly taxing.

There will be a significant amount of time on inpatient services compared to outpatient,

which translates to earlier and longer hours.

After completing residency, you can choose to subspecialize further with a fellowship,

most of which last 1 year. While there are some general orthopods, over 80% decide to

subspecialize, and some even complete two separate fellowships.

In trauma, you'll be dealing with fractures of the long bones of the extremities, such

as the femur, tibia, forearm, and humerus, as well as fractures of the pelvis and hip

socket. Often times these fractures will be “open” meaning the bone came through the

skin and was exposed to the outside world. You'll often be managing intra-articular

fractures at joints such as the elbow, shoulder, knee, and hip. Intra-articular refers to fractures

extending into the actual articulating surfaces of the joint.

Many of the patients will have multiple, if not all, extremities injured in some way necessitating

planning and coordination of multiple surgeries. You'll be working side by side with general

surgery trauma surgeons, as these patients often have accompanying intra-abdominal and

This is the subspecialty for you if you don't mind irregular and unpredictable hours while

on call. You will often see patients on the worst day of their lives, but help them recover

from debilitating injuries in order to get back to a normal life. The surgeries that

you do each day will be diverse and unpredictable, but are often times very rewarding. The pay

is not as high compared to other orthopaedic subspecialties because many traumatologists

treat uninsured patients and are employed by hospitals instead of being in private practice.

Of all the subspecialties, pediatric orthopaedic surgery is the most broad, as you'll be

operating on a variety of conditions in patients less than 18 years of age.

Most commonly, this includes trauma since kids love breaking things. But it also includes

sports injuries, like ACL tears, spine surgeries to correct scoliosis deformity, and deformity

correction of congenital limb defects. You'll see everything from healthy kids who broke

their wrist to kids with multiple congenital syndromes who need multiple procedures throughout

A great deal of pediatric orthopaedic surgery is nonoperative. This is the subspecialty

for orthopods that enjoy a broad scope of practice and have the patience to work with

Spine includes surgical interventions to correct spinal deformity, trauma, degenerative disease,

Spine surgeons are consistently among the highest compensated orthopaedic surgeons.

You'll be dealing with multiple areas of the axial skeleton, operating primarily on

the cervical, thoracic, and lumbar spine, and occasionally the sacrum.

There is some overlap between orthopaedic spine surgeons and neurosurgeons – both

operate on the spine with similar indications and techniques. However, neurosurgeons will

also operate on lesions that effect the actual spinal cord that extend into the dura, which

is the outermost layer of the meninges. As an orthopaedic surgeon, you'll stick just

to the bony spine and leave the spinal cord to the neurosurgeons.

Hand surgery obviously includes the hand, but also the forearm, wrist, and sometimes

up to the elbow or higher! Approximately 70% of fellowship-trained hand surgeons first

completed a orthopaedic residency, but 25-30% of the time it's plastic surgeons. General

surgeons can train in hand fellowship as well, although it's quite rare.

This is the subspecialty for the cerebral and intellectual orthopods. It's the second

most competitive fellowship and deals with incredibly complex anatomy. You have to find

enjoyment in the nuances and esoteric variations of anatomy and function. Given the highly

complex anatomy, you'll be doing a lot of microsurgery, operating under microscopes

or using surgical loupes to better visualize the tendons, nerves, vessels, and bones.

The pathology treated is extremely broad. You'll be dealing with fractures, infections,

nerve compression, degenerative disease, overuse injuries, congenital defects, and traumatic

amputations of the fingers, wrist and hand. Hand surgeons also deal with revascularization

of amputated digits or limbs with repair of the peripheral nerves.

Hand surgeons also do targeted muscle reinnervation, which is straight science fiction. This provides

patients with traumatic amputations to the upper extremity with the ability to use myoelectric

prostheses with more intuitive function. In short, nerves that would have innervated muscles

that no longer have function can be rerouted such that a prosthetic limb can perform more

For example, the starfish procedure allows for independent digital flexion and extension

through a myoelectric prosthesis. Straight craziness. I'll have a link to this paper

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所以，你想成為一名外科醫生[Ep. 7]。 (So You Want to Be an ORTHOPEDIC SURGEON [Ep. 7])

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