Orthopaedic Surgery Preparation: 10 Pitfalls | Osgenic

Quick answer: what should a resident review before an orthopaedic case?

Practical framework—not a validated checklist:

1. Confirm the patient-specific facts, planned procedure, side or site, and documented operative objective.

2. Review the relevant imaging and ask which findings influence the team’s plan.

3. Confirm the planned approach, position, expected role, and level of supervision.

4. Map the procedure-specific anatomy and the broad phases of the operation.

5. Review relevant room setup, imaging access, instruments, implants, and planned contingencies.

6. Agree on one or two learning goals and clarify when questions or escalation are expected.

7. Debrief afterward and record only privacy-compliant educational notes.

This framework synthesizes themes from resident-preparation research, preoperative briefing research, perioperative safety standards, positioning guidance, the AO Surgery Reference, and ACGME supervision requirements. (1, 2, 9, 10, 11, 12, 13, 14, 15, 16)

Pitfall 1: treating one surgical video as the complete operative plan

Surgical video can be useful, but the evidence supports it as one component of education rather than a patient-specific plan. A 2019 systematic review included 20 studies of video in residency education. Videos were frequently supplemented with other learning tools, and some included diagrams or images, audio, or narration. Much of the evidence involved laparoscopic or endoscopic video, so it should not be assumed to apply equally to every orthopaedic procedure. (5)

A randomized pilot study of 22 residents preparing for cadaveric open carpal tunnel release found fewer recorded errors and greater post-procedure confidence among the 10 PGY-1 and PGY-2 residents who received video plus text rather than text alone. The study found no significant performance or questionnaire differences among the 12 more senior residents. It did not evaluate live surgery or patient outcomes. (6)

Practical framework: before using a video, check whether it identifies the clinical context, approach, position, relevant anatomy, major phases, imaging, and limitations of editing. Verify unfamiliar medical or technical claims against a peer-reviewed publication, society or regulatory source, authoritative surgical reference, or an institutionally approved resource. (1, 5, 6)

A video may depict a technique that differs from the current operative plan. Confirm the planned approach and supervising surgeon’s expectations rather than inferring them from the procedure name or video title. (1, 15)

Related Osgenic resource: Browse orthopaedic procedure guides. This internal link is a learning-resource pathway, not an independent citation for medical claims.

Pitfall 2: memorizing steps without procedure-specific anatomy

Anatomy training and simulation research supports careful but limited claims. In a pre/post study, nine midlevel general surgery residents completed a faculty-led cadaveric procedural-anatomy course and had higher simulated operative-performance scores afterward. The study was small, involved general surgery, and did not establish improved performance in live orthopaedic operations. (7)

In a qualitative study of six orthopaedic residents, participants perceived virtual-reality simulation as most useful for junior residents learning anatomy, surgical exposures, and procedural steps. Those findings describe trainee perceptions, not measured transfer to the operating room or patient outcomes. (8)

Practical framework: review the anatomy that is relevant to the planned approach, which may include landmarks, deep intervals, nearby neurovascular structures, tissue at risk during exposure or retraction, and anatomy used to interpret intraoperative imaging. The exact list should be taken from an authoritative, procedure-specific source and confirmed with the supervising team. (14, 15)

A 3D model can be used as a visualization aid, but the sources cited here do not establish that any particular 3D-anatomy platform improves real-world operative performance or clinical outcomes. (8) Explore Osgenic’s 3D surgical anatomy as a supplementary visualization resource, not as a substitute for procedure-specific references or supervision.

Related Osgenic content: Posterior humerus approach. Use the page as an internal study pathway; verify approach-specific anatomy and risk statements against approved clinical references.

Pitfall 3: knowing the procedure but not the patient-specific reason for it

Patient-specificity was one of the four preparation domains reported by residents in the Cadieux study. (1) A separate single-institution survey of 130 surgical residents and fellows found that 57% reported reviewing the patient’s medical record before every operation and 96% reported that they had taught themselves how to prepare. That survey included several surgical specialties, not orthopaedic surgery alone, and it measured self-reported practice rather than patient outcomes. (4)

Indications, contraindications, and alternatives

A general preparation article cannot establish whether a specific operation is indicated or contraindicated for a specific patient. Those decisions depend on the diagnosis, patient factors, procedure, available alternatives, current evidence, local policy, and the supervising team’s assessment. Residents should understand the documented indication and any patient-specific contraindications or alternatives identified by the treating team, but should not infer patient selection from a generic procedure page or act beyond their assigned authority. (14, 15)

Practical framework: confirm, within your role, the diagnosis, side or site, planned procedure, documented operative objective, relevant prior surgery or implants, and any unresolved discrepancy in the record or imaging. Ask the supervising team to clarify information that does not agree. (10, 11, 14, 15)

The Joint Commission’s Universal Protocol centers on preventing wrong-person, wrong-site, and wrong-procedure events through standardized verification and team communication. The WHO Surgical Safety Checklist uses team pauses before anesthesia, before skin incision, and before the patient leaves the operating room. These are institutional team processes; personal preparation does not replace them. (10, 11)

Pitfall 4: preparing for the procedure name but not the planned approach

Residents in the Cadieux study described learning surgeon preferences as part of preoperative preparation. (1) The AO Surgery Reference separates treatment planning, patient preparation, approaches, procedural steps, pearls, pitfalls, and aftercare. That organization supports using an approach-specific source rather than assuming that a procedure label specifies the route, setup, or sequence; it does not itself demonstrate a clinical outcome benefit. (14)

An international 2025 survey of 211 orthopaedic trauma surgeons, fellows, and residents found that common features of formal plans included implant positioning and specific steps of approach and reduction. Because this was a cross-sectional survey, it describes practice patterns and opinions rather than proving that a particular planning method improves outcomes. (9)

Practical framework: confirm the named approach and any modification, patient position, expected exposure, relevant imaging access, your anticipated role, and the supervising surgeon’s current plan. Treat surgeon-specific preferences as case-specific information that must be reconfirmed, not as permanent rules. (1, 9, 15)

Related Osgenic examples: Hip hemiarthroplasty—Hardinge approach and hip hemiarthroplasty—posterior approach. These internal links illustrate approach-specific content organization; they are not used here as independent evidence for indications, risks, or superiority.

Pitfall 5: starting the mental model at the incision instead of the setup

Positioning is a perioperative safety task, not merely a way to improve exposure. AORN’s guideline summary emphasizes patient-specific risk assessment, safe positioning practices, and prevention of positioning-related injury. (12) AORN also recommends discussing position, injury risk, equipment needs, and potential equipment conflicts during the briefing process. (13)

Practical framework: review the planned position, supports, table configuration, imaging access, and procedure-specific equipment at a level appropriate to your role. When relevant, confirm that the team has addressed instruments, implants, imaging, and planned contingencies. Follow the local assignment of responsibilities; a resident’s private checklist is not a substitute for the team’s safety processes. (12, 13, 14, 15)

The Joint Commission states that the final time-out must occur immediately before incision and involve all immediate members of the procedure team. That team process should not be replaced by memory or completed informally by one person. (10)

Pitfall 6: viewing imaging without asking how it relates to the plan

For fracture care, the AO Surgery Reference links diagnosis and treatment selection with approach, patient preparation, technique, intraoperative imaging, pearls, pitfalls, and aftercare. (14) The 2025 orthopaedic trauma survey also found that formal plans commonly addressed implant positioning and approach or reduction steps, although the study did not test clinical outcomes. (9)

Practical framework: ask which imaging findings influence the planned approach, reduction or reconstruction objective, implant strategy, or required intraoperative views. Use a classification only when it is relevant to communication or planning, and confirm its interpretation with the supervising team. Do not convert an educational classification summary into an independent treatment decision. (9, 14, 15)

Related Osgenic reading: Gustilo-Anderson classification. Use this as an internal learning link, not as a treatment directive. Patient care should follow current authoritative trauma guidance, the treating team’s plan, and local protocols. (14, 15)

Pitfall 7: learning a clean sequence without identifying escalation points

The AO Surgery Reference includes procedure-specific planning elements, pearls, and pitfalls. (14) ACGME requirements state that supervision must reflect the resident’s ability and the patient’s complexity and acuity; faculty delegate portions of care based on the patient’s needs and the resident’s skills. Residents must know the limits of their authority and when communication with supervising faculty is required. (15)

Practical framework: for each major phase, identify the intended goal, anatomy at risk, how the team will assess satisfactory completion, foreseeable technical problems described by the approved source, and the threshold for pausing or requesting senior assistance. In this article, planned contingency means a pre-agreed alternative or escalation pathway; terminology should match the supervising team and local practice. (14, 15)

This is risk awareness under supervision, not independent complication management. The attending physician remains ultimately responsible for the patient’s care, while every physician remains accountable for their own actions within the defined chain of responsibility. (15)

Related Osgenic content: Uncemented total hip arthroplasty—posterior approach.

Pitfall 8: failing to clarify role, supervision, and learning goals

A 2025 systematic review defined preoperative educational briefing as a focused discussion of trainee goals and operative strategy. Across 20 included studies, many reported favorable educational or performance measures after implementation, and the authors proposed the Goals, Autonomy, Preparation, and Strategy framework. The evidence base was heterogeneous and does not make every briefing format equivalent or prove a universal effect on patient outcomes. (2)

A much smaller single-department otolaryngology study found that residents and faculty generally valued a four-item preoperative and postoperative tool, but overall teaching-quality scores did not significantly change. Post-intervention response numbers were small. (16)

A retrospective study of 1,945 elective general-surgery case evaluations at one program found measurable gaps in resident-faculty preoperative communication, particularly at the PGY-1 level. The findings should not be generalized without acknowledging the single-program, elective-case design. (3)

ACGME requirements make the supervision boundary explicit: the appropriate level of supervision depends on the resident’s training and ability as well as patient complexity and acuity, and the supervising faculty member determines what care is delegated. (15)

Practical framework: before the case, clarify the part you may observe, assist with, or perform under supervision; one or two learning goals; the supervising surgeon’s key priorities; when questions are welcome; and which findings should prompt immediate escalation. (2, 15, 16)

What residents reported: In the Cadieux study, residents described limited guidance about what it means to be prepared and identified relationships, rotation structure, the operating list, available resources, and time as factors that enabled or constrained preparation. (1)

Pitfall 9: trying to study everything without an explicit priority order

Time was one of the constraints reported in the Cadieux qualitative study, and case complexity was the strongest reported factor influencing formal planning in the 2025 orthopaedic trauma survey. (1, 9) Neither study validates one universal time budget or study sequence.

Osgenic editorial framework—not a validated method:

1. Case facts and supervision: patient-specific objective, side or site, current plan, approach, position, assigned role, and escalation expectations.

2. Procedure map: relevant anatomy, broad phases, imaging, instruments or implants when applicable, and source-described pitfalls.

3. Optional depth: alternatives, controversies, uncommon events, and supporting literature relevant to the individual case.

For a first exposure, anatomy and orientation may deserve more attention; for a repeat case, prior feedback and patient-specific differences may deserve more attention. This is a reasoned study suggestion, not a demonstrated superiority claim. (1, 9)

Pitfall 10: treating debriefing, reflection, and note-taking as the same intervention

These activities have different evidence. In the Zhou study, a briefing-debriefing tool was well received, but overall teaching-quality scores did not significantly improve. (16) In a small pilot survey, 23 of 50 general-surgery residents responded, and all respondents reported some form of operative reflection. The study described mental, written, and oral reflection but explicitly called for further research on effects on competence. (17)

A 2025 randomized trial of 48 obstetrician-gynecologist trainees and attending surgeons used an artificial 50-step task. Participants assigned to write a templated or free-text operative report performed better one week later than controls. This narrow simulation result does not establish that informal personal notes improve orthopaedic performance or patient outcomes. (18)

Practical framework: separate three activities:

• Team debrief: clarify feedback, changes from the plan, and unresolved questions.

• Reflection: compare what you expected with what you observed or performed.

• Educational note: record a privacy-compliant lesson, not a shadow medical record.

Follow applicable law and institutional policy for any information connected to a patient. In the United States, HHS states that mobile or cloud access to electronic protected health information requires appropriate administrative, physical, and technical safeguards and, when applicable, business-associate agreements. Other jurisdictions and institutions may impose different or additional requirements. (19)

As an editorial example, a privacy-conscious educational note might contain the procedure topic, a non-identifying anatomy or technique question, feedback to review, and a source to consult. Do not place identifiable patient information in an unapproved personal application, device, or document. (19)

A six-stage orthopaedic case-preparation workflow

Practical framework—not a validated checklist:

1. Confirm the case facts

Confirm the patient, side or site, planned procedure, documented objective, and current team plan through approved clinical sources. Escalate discrepancies rather than resolving them by assumption. (10, 11, 14, 15)

2. Review the relevant imaging

Ask which findings influence the team’s approach, reconstruction or reduction objective, implant strategy, or intraoperative imaging plan. Use classifications only when relevant and within supervision. (9, 14, 15)

3. Confirm the approach, position, and setup

Clarify the named approach, position, imaging access, procedure-specific equipment, and any source-described positioning risks. (12, 13, 14, 15)

4. Build a procedure map

Summarize the procedure-specific anatomy, broad phases, planned goals, and points where senior input is expected. Do not convert the map into permission to operate beyond the delegated role. (14, 15)

5. Brief

Agree on the resident’s role, level of autonomy, one or two learning goals, operative strategy, and communication expectations. (2, 15, 16)

6. Debrief and reflect

Review feedback and unanswered questions. Keep any educational record within institutional privacy and information-security rules. (16, 17, 19)

Resident case-preparation checklist

Editorial synthesis: before scrubbing in, can you answer the following without guessing?

• What are the confirmed patient, side or site, planned procedure, and documented operative objective?

• What relevant imaging findings influence the team’s plan?

• Which approach and position are planned?

• Which procedure-specific landmarks, intervals, and structures at risk should you recognize?

• What are the broad phases and team-defined goals of the operation?

• Which imaging, instruments, implants, or other equipment are relevant to your assigned role?

• Which source-described pitfalls or planned contingencies should you understand?

• What is your delegated role and level of supervision?

• When should you pause, ask, or escalate?

• What question or feedback point will you review after the case?

This checklist is an editorial synthesis of the cited evidence and standards, not a validated clinical instrument. (1, 2, 9, 10, 11, 12, 13, 14, 15, 16)

How Osgenic fits into the workflow

Osgenic offers procedure-focused learning pages, videos, written steps, anatomy resources, and internal links between related topics. The orthopaedic residents page presents resources for individual learners; the residency programs page presents institutional options; and 3D surgical anatomy provides an additional visualization format.

These statements describe Osgenic’s resources on a first-party basis; they are not independent evidence that the platform improves clinical outcomes. Use any educational platform to supplement—not replace—approved clinical references, patient-specific review, local protocols, team safety processes, and supervised training. (10, 11, 14, 15)