IC 12-2026-My Worst Case and What I Learned: A Panel Discussion of Challenging Cases and Practice Advice for Early Career Members-IC 12-2026-My Worst Case and What I Learned: A Panel Discussion of Challenging Cases and Practice Advice for Early Career Members

Video Transcription

Video Summary

This instructional course, hosted by the AOSSM Early Career Committee, focused on “worst case” surgical complications and lessons learned in early practice. The moderators emphasized that the goal was not to scare trainees, but to create honest discussion about difficult situations not found in textbooks.

Three panelists presented challenging real-world cases:

- <strong>Brian Lau</strong> discussed shoulder instability complications, including a glenoid rim fracture related to anchor placement, later postoperative fracture after a patient moved furniture, anchor breakage with retained implant fragment, and a severe postoperative pan-brachial plexus injury after surgery and an interscalene block. His key lessons: know your implant choices, recognize complications early, use imaging when needed, disclose problems transparently, call for help, and document everything.

- <strong>Evan Velios</strong> presented a complex elbow fracture in a young ballet dancer. The case evolved through multiple complications: intraoperative osteotomy fracture during motion testing, postoperative wound breakdown with exposed hardware, infection concerns requiring wound vac and IV antibiotics, and prolonged stiffness. He stressed frequent in-person follow-up, multidisciplinary collaboration, honest counseling, and maintaining patient trust even when outcomes are poor.

- <strong>Michelle Q</strong> focused on intraoperative ACL reconstruction problems, such as graft issues, tunnel problems, button malposition, graft mismatch, and fixation failures. She highlighted the importance of preoperative planning, understanding team skill levels, having backup plans, and using reps/colleagues for troubleshooting.

- <strong>Beamer Carr</strong> gave a powerful virtual talk about a catastrophic axillary artery injury during rotator cuff surgery that led to bypass surgery, nerve injury, chronic pain, and litigation. He emphasized humility, seeking support, knowing emergency contingency plans, and staying focused on the patient even when outcomes are devastating.

Overall, the session’s message was clear: complications happen, communication and documentation matter, and early-career surgeons should lean on mentors, colleagues, and support systems.

Keywords

surgical complications

early career surgery

orthopedic complications

shoulder instability

elbow fracture

ACL reconstruction

rotator cuff surgery

patient communication

intraoperative complications

mentor support