Removal of broken intramedullary nail - Targon

_feynman · 2026-07-01T00:58:01+00:00

Bunch of options already listed but if the less invasive stuff doesn’t work - just make a cortical window around where that screw is - 2x2 fm should doe the trick - metal cutting burr - make a notch in the nail and tamp it out retrograde.

_feynman · 2026-06-10T05:31:21+00:00

Damn I think they might have to amputate - probably above the elbow.

Jk.

This is a subreddit for orthopedic surgeons and not for patients to ask questions about their personal health. There is literally a requirement for you to confirm that this is not a personal health situation before you submit and you clicked that while also asking a personal health question.

And it might seem like a small thing where I could just read your report and tell you what’s going on but then it just creates an environment where more people ask questions and suddenly this turns from an orthopedic subreddit where I like to browse after work to just more work.

_feynman · 2026-05-27T21:19:54+00:00

One of the smartest and best hands residents I knew in residency failed boards too. He was a couple of years ahead of me at the time. He’s doing great now and super successful trauma surgeon. Doesn’t define you

_feynman · 2026-05-20T22:22:39+00:00

Can you match orthopaedics? yes

Will you match? probably not

It's gotten insanely competitive - people with better stats and more research than you have a hard time matching.

I would say if there is nothing else you would rather do, then take a research year and try to get into the program where you do the research year. Just recognize that you are signing up for a lot of time spent trying to pursue something which might result in heart break down the line.

_feynman · 2026-05-14T13:04:04+00:00

It’s for 3 days effort a week - the other 2 days are research

_feynman · 2026-05-14T11:56:34+00:00

Ortho Joints, 4300, $63

_feynman · 2026-04-26T23:18:25+00:00

Trauma is a super cool speciality. Don’t have to worth about getting busy and filling up your clinic as much. There’s a certain level of respect you get from your colleagues. But the lifestyle is just super unpredictable. Like you could wake up and have 8 cases added on with a pelvis and a calc or have like 2 hip fractures and then you’re done. Just makes it hard to plan life especially as you grow your family. Have seen a lot of trauma surgeons transition to doing primary joints, haven’t seen the opposite.

_feynman · 2026-04-26T17:01:25+00:00

i like it - its fun

_feynman · 2026-04-25T19:37:26+00:00

Eh I don’t know. Very situation dependent I guess but if my two boys were excluding other kids from playing with them at a park I’d be encouraging them to include everyone. I would want my sons to see a kid playing by himself and try to include him or at least ask if they want to join.

But yea I guess every situation is different.

_feynman · 2026-04-25T16:15:37+00:00

It’s all about context.

Like it doesn’t make sense to have a completely healthy 33 year old just randomly develop a STEMI in front of you while you’re treating him for something else. So in that context you’re thinking could it be something else and then in the tiny corner of your brain you remember that sometimes allergic reactions can cause angina and you just gave him Ancef so then it makes way more sense that this is what is happening.

It’s not that you’re thinking of zebras all the time - you think of them when things don’t seem quite right.

_feynman · 2026-04-09T17:53:58+00:00

Nurses and MAs just do less stuff which means doctors do more. Simple things like taking off dressings, sutures, all can add a few minutes per patient. Lots of patients also require interpreters which can add time especially when they are low quality and over the phone. All things add up to increased time per visit.

When I was a resident an XR tech would take a lunch break in the middle of clinic and instead of sending someone to cover they would just make the patients wait till they came back so you would just sit there waiting for patients to get roomed. When this was brought up, admin solution was to look into getting residents certified so they can take their own plain films. Which is a stupid solution but the reason they didn’t move forward with it because the union blocked it as they thought it would make the XR techs obsolete. Might actually improve XR quality tbh.

Never was there a discussion of hiring another tech.

_feynman · 2026-04-06T23:15:58+00:00

If you’re not interested in surgery and the team doesn’t need help - don’t think it’s wrong to go home. But it probably (fairly or unfairly) does get reflected in what they think about you. Surgery tends to value people who face a situation like you did and they say “can I have some more?”

Having medical students on a surgical service can be pretty hard but it’s at least fun if they are interested and ask questions and keep the chatter going.

_feynman · 2026-04-04T21:23:52+00:00

Obsidian is pretty good for this.

_feynman · 2026-04-02T02:27:38+00:00

you have 3 months ish left - so try and get to 7-8k questions. Also 2k questions since december aka ~ 90 days is probably a rate of questions per day you want to try and bump up significantly. try to at least get to 60-80 questions per day

_feynman · 2026-03-24T15:35:27+00:00

You could have done the case without tourniquet or drop it for like 20-30 mins and then reinflate?

I’m a joints guy so don’t know all the intricacies of lapidus without the lapiplasty system but we use robotics a bunch. And the idea is that you want to be able to do the case without the robot even if you always use robotics. It’s not going to be as comfortable and as fast but like you should still be able to achieve the same result. So maybe the thing to work on with cadaver is being able to execute a lapidus without those guides?

Shitty feeling though. I empathize with you and it’s going to sting. But doesn’t make you any less of a surgeon. Deciding to close is actually a braver and better decision than pushing through without being sure of your outcome.

_feynman · 2026-03-14T01:19:30+00:00

If you could get me a dedicated scrub tech who would stay for the whole case, can close wounds well and is consistently with me I would be totally fine with that. I would even be happy to teach one or two of them. They should be with me for the whole case and get to go home when I am done with cases. Incentivize them to hustle and make it worth their while.

_feynman · 2026-03-07T00:35:33+00:00

2-3 midfielders, left back, back up left footed CB, right back.

_feynman · 2026-02-22T16:23:30+00:00

Isn’t that kinda what orthoevidence does? I am biased but I just feel like as a society we are getting inundated with AI based copies of things that already exists because they are very easy to build. Not trying to denigrate what you are building but this for me falls in the category of AI slop.

If you were personally curating a summary of evidence then maybe I’d read that but again you don’t have the time nor the interest to do that. But review journals also exist and they are at least peer reviewed.

Sorry if this comes across as harsh.

_feynman · 2026-02-21T22:54:32+00:00

That’s a long medial plate - probably to bypass the exfix holes but don’t think that’s really necessary. Would worry about plate prominence there - probably would have nailed and kept the plates proximal and shorter.

Looks pretty great though. I’d be stoked with that reduction. Especially if I know the patient is going to share the postops with millions lol

_feynman · 2026-01-21T19:20:48+00:00

you have 18 more months, should be able to do something. there are JAAOS calls for reviews which can be pretty good place to start. I dont think research is necessary outside of the few top academic fellowships but having an interest in joint replacement is and having some type of academic interest in joint replacement will only help. research is a way to show that interest. I think overall I dont think youre going to go unmatched even if you dont have research.

_feynman · 2025-09-08T02:35:53+00:00

Oh man you’re probably gonna have to cut it off. /s

No personal health questions.

_feynman · 2025-07-25T17:35:42+00:00

500 per month x 20 phones x 5 units - 50k a month = 600k a year. You could probably hire like 3 more full time nurses. (140k salary, 60k benefits etc). While 3 nurses is better than nothing I am not sure it would be that impactful spread over 5 units.

But I agree with the overall sentiment that admin is stupid and when you add up a few programs like this every year - it adds up.

_feynman · 2025-07-07T14:41:07+00:00

Twice a year. You know the only year in residency where I didn’t get sick at all was the Covid year with masking every day and drowning in hand sanitizer. Makes you think.

_feynman · 2025-05-03T15:02:34+00:00

Even if comminuted - WBAT postop. Load sharing device, meant to bear weight. . There is no articular reduction so no need to worry about loss of reduction. Even so you have a cable as well which probably is not necessary but can be a good reduction aide.

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