The world is a little less kind now that Robert Small has left.
In Memoriam: Robert D. Small, M.D.

Dr. Small, a much-loved orthopedic surgeon, passed away on July 14, 2015 after a bicycling accident. He was 63 years old.
Dr. Small is survived by his wife of 39 years, Dr. Catherine Butkus Small and his children, Dr. Jennifer (Dr. David) Small-Saunders, Dr. Alyson (Dr. Kenneth) Small Helmandollar and William Robert Small, a medical student at NYU. He is also survived by his brother, Dr. Peter (Dr. Martha) Small of Easton, Connecticut and sister, Deborah (Dr. Howard) Leaman of Salt Lake City. A private funeral was held on July 18.
A memorial gathering was held on Thursday, July 30 at the Women’s Club in White Plains, New York.
Dr. Small, of Briarcliff Manor, New York, worked at White Plains Hospital for over 30 years and served as Chief of the Orthopedic Institute and President of the Medical and Dental staff. He graduated from Tufts University and New York Medical College, followed by an orthopedic residency at the Hospital for Joint Diseases, where he served as Chief Resident, and an orthopedic fellowship at the Hospital for Special Surgery in Manhattan.
Paul D. Fragner, M.D. of the Westchester Orthopaedic Institute called Robert Small a true friend. He told OTW, “My fondest memory of Bob Small is seeing him in the office, every day for 20 years, always in a good mood, happy to be there, and hearing his genuine concern and joyous laughter while talking with patients and their families.”
“I believe Bob would want to be remembered as a doctor who was not only supremely talented, but more importantly as a humble, respectful doctor who truly loved what he did and cared about his patients and co-workers.”
Dot Berman, a nurse at White Plains Hospital, worked alongside Dr. Small for many years. She told OTW, “He was so talented as an orthopedic surgeon and he loved the challenge of a difficult case. He could handle complicated joint revisions and complex fractures with great skill and often made it look easy. You could depend on him to come up with a solution if something unexpected happened intraoperatively. He was always so even tempered and pleasant…it was obvious he loved surgery! He will be missed by all of us in the OR.”

Discussion
This is a fascinating development. In my practice we've seen similar outcomes with the revised protocol. The key differentiator seems to be patient selection criteria. Has anyone else noticed the correlation with BMI thresholds?
Great point. I'd push back slightly on the conclusion, the sample size in the cited study is too small to draw population-level inferences. That said, the directional signal is compelling and worth a larger RCT.
We implemented a similar approach last year. Early results are promising but we're still gathering 12-month follow-up data. Happy to share our protocol if anyone is interested.
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