Orthopaedic Surgery Specialty Review

what is Up Guys Car medic here and welcome back to another dose I'm finally doing my doctor specialty review that I'm probably the most excited about with the one that I've been waiting to make for quite some time and that's orthopedic surgery I've always known that I've wanted to be a surgeon and that I wanted to pursue surgical training and you've probably seen that from my videos over the last few years but I never quite knew which Surgical Specialty I wanted to do and in my F1 year I rotated through vascular surgery and renal transplant surgery and then in my F2 I got the opportunity to do orthopedic surgery for my elective as a medical student I rotated through pediatric surgery and then generally throughout my time in medical school I've had some experience in general surgery Urology and I think that's pretty much it I haven't had the chance to do any neurosurgery and I also haven't had the chance to do any ENT I always knew that I didn't want to do a scope or laparoscopic based Surgical Specialty so those will be things like Urology largely now general surgery and ENT I always knew that I wanted a scalp on my hand I wanted to do something open I wanted to be able to dissect you know the different layers and go into human cavities that sounds kind of weird but within a surgical within a surgical context I promise it's okay and so after this rotation and orthopedic surgery seeing all the hammering drilling screwing all the nails operating on all the different parts of the body we've got the shoulders the elbows the wrist the hips the knees the ankles you know I completely fell in love and orthopedic surgery is the one for me so I'm very excited to take you guys into a deep dive about what this placement looked like for me what it involved what we did Etc so grab some coffee grab some snacks sit back relax and let's chat okay so why did I do an orthopedic oric surgery placement if you guys have been following this channel for a while then you know that orthopedic surgery was not one of the rotations that I was meant to be doing in my F2 year I was actually supposed to be doing paliative medicine but what happened before I moved to my paliative medicine placement is that I got an email saying that the hospice the building where the paliative medicine rotation was organized was being shut down due to some bad concrete or something like that in the building that they needed to look at and so in the meantime they wanted to move me to a medical specialty in the hospital and I emailed back and also CCD in like the training program director the sort of highest person that I could for my training as a doctor in my F2 year and I said listen please please please don't put me onto a medical specialty I want to do surgery I want to be a surgeon and I would love to do any Surgical Specialty but if I get the choice please put me in orthopedic surgery and seemingly by some sheer luck and some amazing you know turn of events I was actually allowed to do orthopedic surgery instead of paliative medicine which was like the best thing to ever happen to me in my F2 year as a doctor and not only that when I got moved onto the placement they didn't want to put me on the Encore rotor because if that building got sorted out they wanted to move me back to P of medicine and so they said put him on a 9 to5 schedule no on calls no nights so that if he has to go back to his original job he can move easily without messing up the orthopedic surgery Rota So Not only was I doing orthopedic surgery the specialty that I was the most interested in and most excited about but I had no on calls and I had no nights pretty much a dream job from my F2 so a few weeks before I started my rotation I went to one of the outpatient orthopedic clinics I knocked on the door and I introduced myself to one of the orthopedic registrars and just said hey I'm going to be starting orthopedic surgery in a couple of weeks I'd absolutely love to spend some time with you in theater come and see what the surgeries are like and get involved and you know the guy was amazing amazing amazing if you're watching this video you know who you are and he really took me under his wing and said yeah of course please come to theater I'm going to be operating on days X Y and Z and so I spent a few weeks with him in theater outside of work so in the evenings and on the weekends on my annual leave Etc and I got to really know both him and the orthopedic team were more widely and so I already had a little bit of sort of in and knowledge and experience in orthopedic surgery before I started my rotation and then a few weeks later my orthopedic surgery rotation began so the team consisted of three f1s one other F2 myself and F2 and then an F3 and two core trainee so ct1 and ct2 level and then I think five or six regars and maybe seven or eight Consultants something like that so it was quite a big team but obviously not everyone was working at the same time every day and on the wards it was generally two or one to three f1s and then at least one F2 and then an F3 or a ct1 so the team of three f1s the other F2 and the other F3 were all girls and we honestly had the best best time like not only did we do our job and you know get everything done but we had so much fun whilst we did it we were constantly laughing you know joking around sharing stories about what we were doing in our time outside of medicine and just had really really good vibes together we all gotone along very well we were very eager to help each other with our our workload we were very good at making sure we all took our breaks everyone got to go to lunch helping people finish on time so that they could leave work at the right time and not stay late it was just a really really great environment of teamwork and this made an absolutely huge huge difference surgical Specialties generally for f1s and f2s can be very difficult jobs and they are very difficult jobs you've often got quite a high patient load and also the patients can become very unwell and you generally don't have very much support from your seniors your core traines and your registers and your Consultants cuz they're always operating in theater they're or in clinic they're not really well they don't really look after the Ws at all and so surgical Wards generally speaking are largely run by and looked after by the f1s and f2s and sometimes like a F3 someone doing a jcf or something like that and every now and again maybe the cor Tres will pay a visit to the ward but it's very very rare and then even in the orthopedic Department you know the doctors we were all really good friends with the physiotherapists the occupational therapists the nurses in charge the nurses just everyone was just such a good vibe I don't know how to describe it like when you're a doctor and you rotate through all these different Specialties so I've done six different Specialties in my F1 and F2 year every time you move jobs you meet a completely new set of people new doctors new other Healthcare staff that surround that role and so you know you meet tons of people and to find and have a job where we got along with everyone on the aard was just really really special and when you're close to the other doctors on your job more than just colleagues like you become friends it just it makes such such a big difference and you know if any of them are watching this video huge shout out to you guys I miss you all the time and I miss I miss all our all our days spent on orthopedic surgery anyway a quick word about the registrars and the Consultants so these are our seniors who spend the vast majority of their time in clinic and in theater and then come up to the Ws to round on their patients with our help every now and again not every day sometimes not every few days Etc depending on the registar but honestly absolutely fantastic so this was some of the best group of seniors who I think were very keen on and wanted to actually teach the Juniors and all the registar maybe bar one of them so six out of the seven you actually felt like they were trying to take you under their wing and they were trying to show you and teach you and get you involved and make you do things you know on Orthopedics you have a lot of very practical procedures so there's a lot of pulling or reducing of dislocated joints or fractures in joints and they were always encouraging us to do them and to watch and to learn and to do them we could gain those skills and do those skills and then when we were in theater they were always very focused on making sure that we got to actually be involved in the surgery to actually do important steps and learn and gain you know surgical skills and learn how to do these procedures and things they were very very very keen to help which I'm forever grateful for so in theater for example you know let's say we were replacing plates with some screws over a fractured radius in the wrist you know they would place the plate they would put in a screw and then they'd be like okay this is how you put put in a screw here's the screw here's the screwdriver take them and you know put in the nail they would watch us do it correct our angle explain to us about the force how much to put tension on it Etc or you know when closing up the wound they would let us suture and they would watch us suture and give us advice on our technique and say you know redo this one or put these closer tighten more here etc etc whatever it is but the point is they were putting in effort in letting us learn and teaching us which is really really important something you don't get a lot of sometimes in foundation training depending on where you are so very very grateful for that honestly it's worth saying again some of the best senior doctors I've ever had thank you as far as the Consultants go I honestly found them all very approachable very easygoing we had all of their numbers on WhatsApp and we could message them at pretty much any time and they were very responsive always like helping sort out the bigger picture larger issues that we might have had that needed consultant involvement and they would always joke around and we'd have a good time in the morning trauma meetings they would also want to teach and be quite keen on teaching and asking those questions so honestly the orthopedic team 10 out of 10 love to you guys Ortho Jerry's versus non-ortho Jerry's okay so what did I do every day as a F2 doctor in orthopedic surgery every single day started out with a morning trauma meeting and this started at 8:00 in the morning I think 8 or 8:30 no 8 8:00 in the morning and this would run for approximately half an hour to 45 minutes running through all the patients of the day so these are patients that are going to get operated on today patients that got admitted from a overnight and patients that are on a waiting list for surgeries to happen and then also patients that needed discussion in a TR meeting to help make a plan for them so this trauma list that we would go through every day was an Excel sheet that would get updated on a daily basis and the shared Drive of the hospital and it was basically for lack of a better words in my humble opinion it was a bit of a mess so you know there was like the section at the top of patients who needed surgery in their par order and then patients for a discussion patients on the waiting list patient and then like urgent and then jobs that needed to get done some were urgent some were not so urgent some needed to be done today some could be done tomorrow it was a little bit of a mess in my Humungo opinion so I think two months into the rotation I took that Excel sheet and I redesigned it and reorganized it I colorcoded the whole thing and I made a traffic light system of urgency so red was super super urgent needs to be done today orange was like pretty urgent needs to be done within the next 1 to 3 days and then green was something that you could work on throughout the week didn't need to happen right now and I wrote like a little paragraph say you know hello this is the new traffic light system for for this trauma list this is how it's going to work this is what it looks like and I just saved it and then the next day in the morning we were in the trauma meeting and one of the regars was like running through it and all the Consultants were sitting there and one of them's like who did this like who changed the trauma meeting list or whatever and I remember sitting there in the corner like feeling like anxious and nervous and scared and I was like me I think my voice cracked when I said it as per usual and everyone started laughing cuz they're like H he's so scared but BL anyways the long story short is that the the consultant loved it they thought it was a great idea and it it all went well and then after that morning meeting we would basically split off with the Juniors going to the wards and then the registar and the Consultants going down theater or to Clinic wherever they needed to be so on the wards it was largely split in two so we had the orthogeriatric patients and the not orthogeriatric patients so orthogeriatric patients are patients in our depends on the hospital you're in but in our hospital it was patients above the age of 65 that were admitted under or and then non-ortho patients were patients under the age of 65 who admitted under Orthopedics and the reason we have this distinction is that this class or this group of patients have an unusually high mortality rate in the hospital they're elderly usually with major injury to the Bone so large fractures of the hip of the knee of the shoulder whatever and so they're physiologically quite severely impacted and they're more prone to becoming really unwell or not surviving their length of stay hospital and this is especially true for NEC of fale fracture patients so we call these kns NF Neco femur fracture patients these patients have a particularly High mortality rate as a group of patients in the hospital so the orthogeriatric team would see the orthogeriatric patients with a consultant wardr on Monday Wednesday and Friday and then on Tuesday and Thursday there was no consultant the Juniors would Ward around those patients so the orthogeriatric patients would be seen by the f1s with a consultant on Monday Wednesday and Friday and then on Tuesday and Thursday it would just be the F1 seeing them and the non ortho geriatric patients would be seen by myself as one of the f2s or one of the other f2s or f3s um and we would see and deal with those patients so for the f1s on the rotation this was helpful because there would be a consultant plan for these patients coming to see them on Monday Wednesday and Friday so they could basically just follow that plan and you know you obviously deal with any patients that become unwell in the meantime Etc but their plan was pretty much sorted for them then for the non orthogeriatric patients they were basically just seen by me or the other f2s or f3s on the ward which was great because this leads to a lot of Independence critical thinking clinical decision- Mak Etc and I've talked about this before in my other review videos like this the parts of this job that I enjoy the most are when I actually get to be a doctor you know following around a consultant with a computer typing up the notes following their plan Etc is not what I want to do it is very much something that you know I was happy doing when I was in F1 and maybe early on in my F2 but after being on acute medicine and having a lot more kind of responsibility and ownership over clinical decisions for patients I've really really enjoyed that and I've taken that with me throughout orthopedic surgery and then even further in emergency medicine which is my next rotation that I'll talk about in another video but basically you know starting to get this autonomy and responsibility in decision- making for the patients is you know ultimately what being a doctor is about and that's what I liked about this Orthopedic job so much is that I got a lot of freedom and Independence reviewing patients on my own making decisions for them and of course if I was unsure of anything or if I needed further advice seniors were always available and around and I could always reach out to them and I did many many many times but just the fact that you see the patience by yourself you make the plans for them you do the jobs for them you follow up on what you've done you see if there's good outcomes if there's not so good outcomes you adjust for the next time this is what being a doctor is all about I absolutely love this on orthopedic surgery okay next section firms so how orthopedic surgery was broken down was as follows so you had within the big group of consultants and registrars you had a team for Foot and Ankle a team for hip and knee a team for spinal surgery or two teams for spinal surgery and then there was another one Upper Limb yeah so shoulder and elbow basically yeah that was it so you had designated consultants and registar for each of these different sub Specialties okay and so for example if I came across a septic knee patient that had had their third wash out yesterday and was now bleeding everywhere on the bed and I needed to contact somebody about this I would need to contact the hip and knee registar preferably the one who did the surgery but if they're not there the hip and knee registrant who could then Le with the hip and knee consultant and so the f1s were attached to a set of Consultants who were attached to a set of registar and so on days when the spinal team came and they wanted to see their spinal patients they would call that F1 and they would take that F1 with them see all the patients and the F1 would document and do the jobs etc etc so we kind of had these like smaller groups within the big orthopedic surgery specialty and this was quite useful because when you had a problem with a specific patient you could contact the specific person about that problem now if the registar for that particular Subs specialty wasn't there then you could talk to someone who's cross covering that specialty and we had this like little paper on the wall that said who's cross covering who and when and blah blah blah and if they weren't there then you could call the oncore red St but was typically super super super busy and generally not very available to help with these things although they they would but they're kind of the last qu of Co because they're so busy and have their own Bunch stuff to deal with okay surgery time so I tried to go to theater as much as humanly possible I would go during the day if the workload allowed for it I'd go in the evenings I'd stay late I even came in on the weekends on on my annual leave to come in and do extra theater time this group of senior doctors were just so good that I was like I want to spend as much time as possible with them in theater because they're they're teaching me so much they're helping me learn so much and they're letting me do so much it was just such such such a valuable surgical placement experience now the underlying problem was that there was just so much work to do up on the wards that it was very difficult for us to get enough free time to go down theater during the day during working hours so we had like I said three f1s me as an F2 another F2 and F3 and then two core trainees and a whole bunch of registar so the core trainees and the registar it is their job and it is their requirement to get trained in surgery and to become surgeons so their priority is surgical training and they spent as much time as possible in theater and they had priority to be in theater all the time basically so they would never come up to help on the ward so that we could go down theater cuz that's just not how it worked they had priority and they were always in theater if there was extra availability or they weren't around or if one of the registrars needed an extra person then we could go to theater if that makes sense now the annoying part about this is that what this meant was that registar were often inviting me to come to theater I'd see them in the morning or I'd see them walking around the hospital and they be like Oh I'm doing this case in the afternoon you should come and like be my assistant and I'm like yeah that sounds absolutely amazing I definitely want to be there except you know I have 10 patients upstairs that have a bunch of jobs that need need doing and I have two f1s who also have their own patients and are going to need my help and we know we all need to support each other to finish that workload so that we can go home on time if I come down to theater and operate for two to three hours then all that stuff upstairs is going to get delayed and this really really really really really bothered me because we just needed to be better staffed so the wards could be taken care of so that there was time for someone to go to theater every damn day so we could also get trained in surgical skills and get operating time and theater time and blah blah that but we were often way too busy up on the Ws to send one of the Juniors down to go operate in theater so really annoyed me as you can probably tell and what I ended up doing is I made a surgery radp so I looked at the road top for all the Juniors for the next few months and I identified days when we would be well staffed enough on the ward that one of us could go to theater in the morning or in the afternoon so let's say we had I would need something like a minimum of four people on the aards if we happened to be five people working that day one person could go down to theater and spend the day operating so I made this Rota and I allocated each one of us days where we would go to theater and you know in the morning I would just say to the team I'm like you know you're not coming to the wards you're going to theater you have your theater day today and then you know in a few days time that would be me and I'd leave everyone on the Ws and I'd go to theater and this way we actually managed to go to theater and we actually managed to spend time operating either for a full day or just in the morning or just in the afternoon depending on how busy things were upstairs but with this rotor that I made we identified days where we would be well staffed and we could from the beginning say you're going to theater and the registar and the Consultants they love this they were super super supportive of the idea they're like that's great we want you guys to be in theater we don't want you to be taking care of the Ws all day so you know if you can figure out a way to take care of the awards and also sentent theater that's excellent and in fact they loved this so much that in the following rotation when I was on emergency medicine and the next set of Juniors came into orthopedic surgery they implemented this formally and so from the very beginning there was a surgery Rota and an on call Rota where a junior was attached to theater or attached to the Encore regar for the whole day which is amazing that's that's literally what I wanted to to do and that's what I did but only for about a month and a half towards the end of the rotation but it's great I'm very happy that they implemented that it's exactly what the Juniors need on that job to get into theater time and so yeah props to all the senior team for for making that happen now let's talk about the actual surgery and being in theater cuz you know this was some of the best best best experience I've ever had in my life so like I've talked about before the environment in theater was extremely welcoming it was extremely like it was fostering a good healthy teaching inv environment it wasn't stressful it wasn't you know you're doing this wrong why did you do this it was just very what's the word here it was supportive supportive and friendly of the junior doctors okay to to teach them and to get them to learn and actually do stuff in theater and I'll never forget the first time that I drilled into someone's radius so that's the external or lateral bone in the forearm and we were putting a plate someone had a broken wrist and my senor he places the plate you know takes the drill and drills a hole into the radius and he's like talking me through all the steps whilst we're doing it and after he does it he turns to me and he's like all right walk me through what we just did and I explain the whole thing to him and he's like okay it's your turn and he just hands me the drill and I'm like it's go time so run through the whole thing again and then under his guidance and his supervision drill my first ever hole through a radius which was absolutely amazing like I literally I still can't forget it and then plac the screw in it afterwards and it was just such a good feeling it was like this is how you do it run me through the process to show me that you know what you're doing and then under the supervision and guidance of the senior you perform the thing proving that you can do it and then next time you can do it this is what this is what training is all about this is what we want as juniors in surgical Specialties as aspiring surgeons I mean it was just it was amazing and so yeah during my time in theater I saw so many things I mean let's just start head to toe so you know a lot of shoulder arthoscopy repairing rotator cuff muscles and different uh ligaments and tendons to help provide shoulder stability I didn't see any shoulder older fractures I don't think a lot of elbow fractures so particularly elron fractures that was quite common dislocations of the onar radius of the elbow and then loads of wrists plenty of people falling on outstretched hands and uh breaking their wrists I saw one finger surgery I think that was it and then hips plenty of hips so you know arthroplasties Hemi arthroplasties so these are full hip replacements or half hip replacements using dhs's Dynamic hip screws or intramed Nails what else knees loads of knee AR oscopy so plenty of people with septic arthritis of the knee so going in with your three ports and doing your massive wash outs what else few knee fractures actually so tibio Plateau fractures I think I saw and what else oh yeah femur fractures too that was interesting and then also plenty of ankles loads of ankle fractures uh from people rolling over you know on their ankle or falling from large Heights or whatever it was and some spinal surgery I was involved in I think three spinal surgeries what are they called again T lifts yeah that was it transfer Lumber inter body Fusion okay no wonder I didn't remember it just remember as TT anyway so yeah I saw a bunch of spinal surgery in the survival spine in the lumbar spine and in the thoracic spine as well so wide wide range and then what else did we see Achilles T I'm just reading off my notes Here Achilles tendon repairs halix valgus deformities so this is deformity of the big toe in the foot a lot of joint injection so steroid joint injections yeah just every I mean the variety of things that you do in orthopedic surgery is just so so so I I loved it was truly amazing and like I'm a massive nerd when it comes to all of the the tools and devices that are used in surgery I think it's incredibly incredibly interesting and I'm going to be doing a masters in medical Robotics and image guided intervention over the next year and I'm so so so excited to learn about these things I think you know the design of these tools and their ergonomics and the intuitiveness of how pieces fit together and you go from step one to step two to step three almost by default in using the tool it's so so so interesting I'm a massive nerd when it comes to this stuff so I'm really excited to uh to study it yeah you know I'd be in theater holding all these plates and screws and and instruments the drills and everything and just looking at them and thinking about how they work and who designed these and anyway I'll talk about that a lot more in a future video but surgery was amazing is the bottom line here and honestly the best part about all of this was just the teaching so you know before before we'd go in surgery me and the registar we would review the relevant Imaging that we had whether that was an x-ray an MRI a CT scan whatever and then we would say and then he would say she would say we're going to do this approach in order to fix this thing and we would read up on the approach talk through all the different steps they would tell me you know what you'll expect to see in this step once we've done this once we've done that and then when we're scrumped up in in theater and actually doing it you know they would look and they'd be like what is this you know what step are we at what are you expecting to find once I dissect through this muscle blah blah blah blah and so you know it was just really really good enforcement and learning of what we had just talked about running through the case actually doing the surgery closing up seeing the patient on the ward just what an amazing rotation honestly 10 out of 10 now let's talk about the Rota okay so let's talk about the Rota so the Rota is the schedule and you know if you've seen my previous videos you'll know just how much the schedule changes between the different jobs that you rotate through but I mentioned before in this video that when they moved me from paliative medicine to orthopedic surgery they decided to keep me 9 to5 not on the on call rotas no nights no evenings nothing on core in case I had to move back and actually I didn't end up moving back to the entire rotation so I stayed 95 Monday to Friday for the entire rotation now in terms of having a good work life balance this was amazing you know working 95 Monday to Friday is something I've never done in all my time being a doctor and it was incredible you know usually we're working weekends we're working nights we're working in the evenings on sociable hours blah blah blah so this was a huge huge change so so that was the benefit of this Rota the thing that I missed or I lacked from this Rota was the experience of being an surgical Sho on clinic so what this means is that in the evenings and on nights and weekends you cover multiple different surgical Specialties so in our Hospital you covered orthopedic surgery Urology and general surgery when I was in F1 the Royal free and vascular surgery last year at night and on the weekends and on the evenings I would cover vascular surgery orthopedic surgery Urology and general surgery so I had some experience doing this but as an shl as an F2 you get a lot more responsibility particularly in the place of referrals so when you're in shl you take referrals for these Specialties which means other doctors call you from A&E saying hey I have a patient I want to admit under your specialty and they refer that patient to you so you gain a lot of experience in being able to take referrals and this is something that I did not get experience and because I was not on the oncore Rota in orthopedic surgery I would have loved to get that experience and it would have been very uh useful and very valuable for me in my future surgical training but at the same time I will get that experience in due time Tok I didn't need to get it now and on the flip side I got a very stable and secure schedule I had a lot more free time in in my in my life and I managed to have a good work life balance so from an intellectual point of view I would have liked to gain all that knowledge but from a lifestyle point of view it was very beneficial so it's a tossup the f1s were scheduled to work from 8: to 4: I very very rarely saw them finish at 4: they almost always finished at 5: if not 5:30 sometimes 6 and you know I would always be there until they finished I never left before they did and it just sucked for them cuz they they're not getting paid for that time they're supposed to be there from 8:00 to 4:00 but they still have loads of work to do until you know 5: if all the f1's left at 4 I would be there until like 800 or 9 finishing that work so they would stay until about 5:00 and then hand over the remaining work I would finish that till like 5:36 and then go home so we would all stay late usually by at least an hour which was not very nice but part of the BS of of the job unfortunately okay all right let's talk about patience and their emergencies in an orthopedic surgery perspective context so there are a few orthopedic surgery emergencies so one of them is compartment syndrome compartment syndrome is when a compartment of the body usually a compartment containing muscles so inclosed in a fascia becomes swollen or inflamed or increases in size for whatever reason due to swelling or infection or inflammation whatever and becomes swollen swollen swollen within a contained space within that compartment and this is something that needs urgent decompression and if you identify it it needs emergency surgery that needs to happen within I think 30 minutes or an hour and this is done in a few different ways but commonly you can do needle decompression which is when you literally take a needle and stick it into that compartment wherever that muscular compartment is in the arm or in the thigh or wherever you can do fasciotomy which is I won't put up a picture on screen but you guys should Google that if you're into this kind of thing but where you kind of cut a whole series of lines down to the level of the fascia to allow that s in to kind of decompress and release on its own nice and slowly other Orthopedic emergencies we have septic arthritis so this is infection of a joint space so this can be anywhere in the body can be in the hip the knee the shoulder but most commonly it's going to happen in the knee or in the hip I think are the two most common ones and this is an infection inside the joint space which is very bad because it can lead to permanent non-reversible damage to the soft tissues in the joint within about 8 hours or so of onset of in infection so that's another emergency that needs dealing with immediately and this is done through a washout so in the knee for example you take the knee you place um a few ports and then you can go in with a camera and with effectively as a tube for irrigation and you just pump liters and liters and liters of saline solution into there to try and drain out any of the infected material any of the bacteria Etc you can also debde some of the soft tissues or some of the joints Bas if you can see that it's already dead or damaged or infected and so you need to clean out that joint that septic arthritis then Cordina Cordina is an emergency but this will be dealt with neurosurgery not with orthopedic surgery depending on where you are what hospital you're in Etc in our Hospital anyways it was dealt with by neurosurgery and these patients get referred uh to neurosurgeons at a different hospital but some places or be ex surgery deal with that and then lastly fractures to bones that compromise the vascular Supply to that bone so there's a few bones in the body where if you break them they are very high risk of losing their blood supply and going into what we call avascular necrosis so avascular not vascularized not receiving blood flow necrosis necrotizing necrosing death of the tissue basically so so examples of this would be the scaphoid bone in the wrist the navicular bone in the foot and then you can also get this of course with intracapsular necem fractures I saw a lot of septic arthritis actually mostly in the knee I saw one navicular bone fracture in the foot um I didn't see any compartment syndrome whilst I was an orthopedic surgery but I did see a patient with compartment syndrome overnight actually when I was working in acute medicine in my rotation before orthopedic surgery yeah I didn't see any Cino whilst in Orthopedics but whilst working in emergency medicine I saw quite a few cquin cases so yeah so and funnily enough with compartment syndrome it's the one thing that you learn about in medical school over and over and over and over again this gets drilled into your head compartment syndrome being this really big emergency that needs immediate Orthopedic input okay so conclusion time just going to come right now and say this was a 10 out of 10 rotation for me the best rotation out of all of my jobs that I've done as a F1 and F2 doctor very very very happy with it I honestly had such such such a great time and it's helped confirm for me that orthopedic surgery is the specialty that I want to go into which is great news cuz now I know and I can just sit down and focus on that and yeah just the level of Independence the support from the seniors the amazing team of doctors and other Healthcare professionals that I was surrounded by during my time just made for truly an amazing experience I really really loved it and I'm so grateful that I got moved from ptic medicine and wasn't given the opportunity to do orthopedic surgery um so touchwood had an absolutely great time and yeah that's it for me that's it for this video maybe in a few years from now I'll make a video titled I'm an orthopedic surgeon so just give it a few years and we'll get there eventually I guess anyways that's it for me I'm going to go to the gym so I can be an ortho bro in due time and I'll catch you in the next video thanks for watching peace PE