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Introduction: Burnout has implications for surgeon wellbeing and patient care. We aimed to: (a) describe burnout levels among orthopaedic surgery residents in an Accreditation Council for Graduate Medical Education-International (ACGME-I) accredited programme; and (b) determine associations between burnout levels and resident characteristics, resilience and coping mechanisms. Methods: This is a grant-funded, cross-sectional questionnaire-based study that included 44 orthopaedic surgery residents. Burnout was measured using Maslach Burnout Inventory and resilience was determined using the Short Grit Scale. Coping mechanisms were determined using the Brief Coping Orientation to Problems Experienced scale. Results: 20 (45.5%) residents fulfilled the criteria for burnout. High levels of emotional exhaustion (EE) and depersonalisation (DP) correlated with stressors, such as inadequate sleep (EE: r = 0.43, p < 0.01; DP: r = 0.33, p < 0.05), conflict between family and work (EE: r = 0.40, p < 0.01; DP: r = 0.40, p < 0.01), financial pressure (DP: r = 0.46, p < 0.01), and conflict with residents (EE: r = 0.35, p < 0.05; DP: r = 0.34, p < 0.05) and faculty (EE: r = 0.44, p < 0.01; DP: r = 0.35, p < 0.05). Severe burnout was associated with lower grit scores (p < 0.05). Coping mechanisms, such as planning and positive reframing, were protective while behavioural disengagement and substance use may increase burnout risk. Conclusion: Burnout was high in our ACGME-I accredited programme. Stressors associated with higher burnout included feeling of inadequate sleep, poor work-life balance, poor relationships with fellow residents/faculty and financial pressures. Residents should be educated on protective coping mechanisms and regular screening to detect burnout should be performed.

Surgical drains are commonly used in surgery to reduce post-operative fluid collections. Whilst rare, a retained surgical drain may result in clinical complications and distress to the patient. A retained surgical drain is a potentially avoidable event and surgeons should be aware on how to confirm the presence of a retained surgical drain. We report a rare case of a blood clot masquerading as a retained surgical drain in a patient. The patient is a 55-year-old Malay male who presented with left gluteal necrotizing fasciitis. The patient underwent a further 5 debridements with subsequent closure of the wound. Two drains were inserted on closure. Whilst there was no difficulty in removal of the drain, post removal magnetic resonance imaging revealed a tubular structure in the left gluteal region, thought to be a retained drain segment. Intra-operatively, the drain segment seen on magnetic resonance imaging (MRI) was not found and instead, a tubular blood clot of similar caliber and length as measured on the MRI was found residing in the gluteal region. This case highlights the need for confirmation of a retained drain segment before surgical removal. Surgeons should be certain of the presence of a retained surgical drain before advocating for surgical removal. Plain radiography remains a useful modality for visualization of radioopaque surgical drains.

The EndoButton is a commonly used device for femoral fixation of anterior cruciate ligament grafts. Complications from its usage remain rare. Incorrect femoral tunnel placement may increase the risk of intra-articular displacement of the EndoButton. We present a case of anterior femoral tunnel placement resulting in intra-articular displacement of the EndoButton after failure. A 24-year-old man presented to us after failure of anterior cruciate ligament reconstruction performed 3 years prior. Radiographs revealed an intra-articular displacement of the EndoButton. Intraoperatively, it was noted that the femoral tunnel exit was within the suprapatellar pouch, with the displaced EndoButton lodged between the posterior aspect of the lateral tibial plateau and the capsule. Intra-articular displacement of the EndoButton is a rare complication and has only been reported twice in the literature. Anterior placement of the femoral tunnel may predispose patients to this complication and it is recommended to check the EndoButton position intraoperatively to avoid such a complication, especially for the unexperienced surgeon.