How to handle pressure

Insight from the AO’s Ignacio “Nacho” Calvo
Blog Calvo Pressure

Handling pressure is part of any surgeon’s job, but it is not a skill you can master in a day. As surgeons grow in their careers, they take on greater responsibilities and with that comes higher pressure. Here, Ignacio Calvo, known by his AO friends as "Nacho," shares his experiences with the AO community and gives us an insight into how he handles pressure, all through the prism of one specific case.


This case was something that happened when I was with the Royal Veterinary College in London. The cat had complex injuries: fractures in both femurs, a luxated hip, and the distal femur fracture was supracondylar—one of them with an articular component. When you’re looking at something like that, the AO approach to fractures is a huge help.

The complexities of this case went beyond the immediate injuries. The treatment and healing process would also have its challenges, as the cat needed to use both affected legs sooner—to walk on them. If only one leg is broken, then it can be protected while healing is underway. You can form the plan, take the necessary images, and plan your fixation strategy. In this case a biaxial plate was used to add stability to the distal femoral fracture as it healed.

The other aspect to the pressure, beyond the initial injury, treatment, and healing, was the knowledge that in this case the owner would not be able to devote the time needed to care for the animal in the case of complications. In that scenario, the animal would be euthanized.

Handling pressure is part and parcel of any surgeon’s job. I was lucky that my father was an orthopedic surgeon and an AO member. Although he specialized in human medicine, we had a lot of discussions about pressure. The main takeaway from these talks was always: Preparation is the key to handling pressure well.

If you have done the diagnostic steps required and you have reached a diagnosis, you have your strategy in place (complete with plans A, B, and C for different scenarios) then you’re on the right path. If you can be confident that you have executed the plan to the best of your abilities, considered possible issues and done the follow-up, then the risks of complications (and the pressure that comes with that) are significantly reduced.

In my case, the cat with polytrauma, I had the additional pressure that the owner was considering euthanizing the animal if the outcome was suboptimal. This is a lot to deal with. I knew I could not change the pressure the owner was putting on me; I could only maximize the chances of a good outcome.

I knew that with a case this complex, I had to be at the top of my game regardless of the pressure. I ensured I was ten out of ten—my level best—and kept my eye on the details.

About the author:

Ignacio “Nacho” Calvo, Ldo Vet, PhD, CertSAS, Dipl ECVS, MRCVS, practices small animal orthopedics at VETSIA Hospital Veterinario in Madrid, Spain. He currently is chairperson of AO VET Europe and Southern Africa (AO VETESA). A 2001 graduate of the University of Cordoba (Spain), Calvo did his surgical residency at Glasgow University School of Veterinary Medicine, became an ECVS Diplomate in 2012, and earned his PhD in 2016. Additionally, his postgrad studies at the University of Glasgow helped him earn a Post Graduate Certificate in Academic Practice (PGCAP) and a British Higher Education Academy Fellowship. He has close ties to the ECVS and currently is a member of the ECVS Examination Committee. Calvo was a member of the AO VETESA Board and the AO VET Education Commission from 2018–2021 and served as the AO VET representative to the AO Faculty Alignment Group from 2020–2021.

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