D. Joanna Kim, MD | Vibav Mouli, MD, MS
May 8, 2026
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PGY-2 year of orthopedic surgery residency is often the busiest year of residency – juggling consults in the ED with increased OR expectations and management of patients on the floor overnight. It is also one of the most formative years when surgical growth really accelerates. The foundational skills – soft tissue handling, exposure, drilling and screw placement, fluoroscopy, fracture reduction – thread through nearly every case. To make things as concrete as possible, below are 10 key procedures that typify these skills:
1Distal Radius ORIF:
Master the volar Henry approach.Clean exposure here makes reduction and fixation easier. Soft tissue handling is the foundation of all surgery—start building it here.
2IM Nailing (Femur, Tibia):
Setup is everything. Before draping, you should own your patient positioning, fracture table setup, and fluoroscopic visualization. For rotation and length, know which intraoperative references you’re using—these decisions happen early and drive your outcome. A well-prepared setup leads to smoother execution!
3Ankle Fracture ORIF:
Drilling and screw placement become instinct here. Feel the difference between near and far cortex. When placing a lag screw, know when you’ve crossed. Develop efficiency of movements with clean drilling, accurate measurement, smooth screw placement.
4Syndesmotic Fixation:
3D anatomic understanding is tested in every step. Perfect your mortise and lateral views. Know how to confirm reduction, as subtle malreductions are common and consequential. For example, during fixation, your drill angle should naturally reflect the fibula’s posterior position relative to the tibia!
5Supracondylar CRPP:
Fluoroscopy guides everything. Learn to maintain your reduction while switching views, and to adjust pin trajectory in both coronal and sagittal planes. Use prior k-wires as spatial reference for the next one.
6External Fixator:
Plan before you cut. Map pin sites outside the zone of injury and future approaches. Ask yourself: does this frame control length, alignment, and rotation? Perhaps most importantly, understand safe zones. This translates outside of the OR too, when you are often asked to place traction pins on the floor to temporize fractures!
7Medial Parapatellar Approach (TKA):
This is bread and butter orthopedics and one of the most fun approaches to learn as a PGY-2. Know your landmarks—quad tendon, patella, medial border—and execute a clean arthrotomy. Retractor placement is everything; poor positioning can lead to poor visualization and inefficiency.
8Diagnostic Shoulder Scope:
This is your introduction to triangulation and 3D arthroscopic orientation. Accurate portal placement comes first – everything else follows. You have to build a systematic diagnostic sequence and repeat it every time.
9Diagnostic Knee Scope:
This is all about refining your efficiency. Just like in the shoulder scope, you have to own a consistent sequence: suprapatellar pouch → patellofemoral → medial compartment → notch → lateral compartment. Normal anatomy matters as much as pathology!
10Deltopectoral Approach (TSA):
A foundational open shoulder approach. Identify the interval deliberately, manage the cephalic vein atraumatically, and understand the relationship between the conjoined tendon, subscapularis, and neurovascular structures. Know when to move and when to slow down near critical anatomy.
PGY-2 is a lot of unglamorous repetition. But that’s the point! Each case is a chance to fix one small thing—your portal placement, your drill trajectory, how you set up the room. The year goes fast, and the residents who come out the other side strongest are the ones who stayed curious when it was hard.
DISCLOSURES: Dr. Kim This individual reported nothing to disclose. Dr. Mouli This individual reported nothing to disclose.
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