Should you do an Ortho Sports Med elective?

Should you do an Ortho Sports Med elective?

I have to admit, I’m biased to answer yes to this question. When I was a pre-med I wanted to be an orthopedic surgeon, due to an adolescence filled with patellar dislocations and repeat visits to the ortho office. At one point I received a Hanger leg brace in exchange for a product review, and when a childhood hairline patellar fracture “grew up” into an avulsion fracture I asked the surgeon if I could get video of my arthroscopy (I got photos, but no vide). Small surprise I went into medicine – but it turns out I really don’t enjoy the OR, so all the surgery specialties went out the window!

Benefits of an ortho/sports med elective?

Yet, as a surgery-disinclined fourth year, I chose to do an ortho/sports med elective. Why? Because there is a TON to learn for a future family medicine doctor. I always ask what a specialist would love for referring docs to do prior to sending over a patient, and what I expected to hear was “get x-rays” – but that’s not the case, as most ortho docs will either have in-house imaging or have a relationship with one nearby. Instead, what I heard most was that patients need better preparation. Sending your patient for evaluation? Then let them know that conservative options will be explored before leaping into surgical treatment; from anti-inflammatory drugs, to the use of joint injections and occupational therapy, there’s more to ortho than the knife!

What are the negatives?

You can’t spend all day in the office, learning about viscous versus steroid injections and practicing your special tests. A lot of time on your ortho/sports med rotation will be spent in the OR, and much of that will be focused on joint replacement or fracture repair. If the sound of a bone saw sets your teeth on edge, or your T-rex arms cause your retractor-holding skills to be lacking, this may not be the right rotation for you. But if you can appreciate a little hammer & saw, want a good refresher on anatomy and can endure the arctic chill of the OR, it’s well worth your time.

Ortho/sports med Tips

• What kind of plain films should you get for knees and hips? Weight bearing – because it shows how the joints really look most of the day.
• Should you try to get an MRI? Not before you get plain films. I’ve learned most insurance will typically refuse to get an MRI prior to plain films, but don’t do it even if  you can. It’s often a waste of money.
• What can you do to help a joint replacement patient succeed? Encourage them to be committed to their physical therapy regimen and work through that tough first week post-op
• LEARN THE SPECIAL TESTS. You cannot do an ortho/sports med rotation without knowing how to differentiate whether knee pain is due to the knees versus the hips.

Two weeks? What’s the Point?

For family medicine I think two weeks is perfect, although if I could do another two weeks in a pediatric sports med office it would be great. I’ve learned so much more about arthritis of the knee and hip, carpal tunnel, trigger finger, De Quervain’s, various forms of tendinitis, rotator cuff tears, adhesive capsulitis (AKA frozen shoulder), joint injections (steroid and viscous), scaphoid fractures, conservative pain management, bursitis, meniscal tears, occupational and physical therapy, ulnar triangle tears, fractures of fingers/wrists/arms, avascular necrosis, arthroscopy, gouty tophi and patellar femoral syndrome.

I’ve also learned a great deal about joint replacement and aftercare, including post-op wound care and labs to watch, and the need for early mobility & aggressive physical therapy. I understand why ortho docs prefer their patients get antibiotics for any dental procedure or respiratory infection – you do not want to tell a patient their joint has to come out due to bacteremia.

It was a great rotation and I learned more than I expected, which is always awesome.

 

 

 

References

• Orthobullets – Great site for re-visiting anatomy, physical exam tips and basic ortho knowledge (Wound & Hardware Infection, Prosthetic Joint Infection, Total Hip, Total Knee, Implant Fixation)
• Review your radiology