Operation FUBAR: Eight Challenging Hips with Nick Mast

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What do you do when the foot slips out of the traction boot mid-case — and a manageable periprosthetic fracture becomes a femur in pieces? Dr. Nick Mast has an answer, because it happened to him.

Nick Mast, a hip and pelvis surgeon in private practice in San Francisco, trained under Joel Matta at the Hip and Pelvis Institute in 2007–2008 and completed hip preservation training in Europe. He's also a second-generation surgeon — son of fracture-surgery pioneer Jeff Mast — and his practice runs heavy on the cases other surgeons send away: complex trauma, revisions, non-unions, and malunions. For this Operation FUBAR episode, he brings a career's worth of them.

The case series spans a 35-year-old malunited both-column acetabular fracture with protrusio (in a yoga instructor), the reverse femoral-head grafting technique he learned from Frédéric Laude in Paris, bilateral Crowe IV high hip dislocations, converting a failed PAO in a Perthes hip, post-traumatic arthritis with intrapelvic hardware, geriatric acetabular fractures treated with fix-and-replace, simultaneous bilateral Perthes replacements — and the recent one: an osteoporotic periprosthetic fracture revision where the foot came out of the boot and the leg fell, comminuting the diaphysis mid-case.

The most valuable part may be what happens around the surgery: how Mast keeps a room calm by lowering his voice instead of raising it, the pack-the-wound pause he learned from his father, the mid-case calls to trusted colleagues that produced the solution, how he reads bone quality on a plain radiograph (the "third-third-third" rule), and why his practice has shifted toward French-paradox cementing. For anterior approach surgeons, fellows, and residents, this is a masterclass in complex hips — and in composure.

⏱️ Chapters:
00:00 What Operation FUBAR is
01:01 Introducing Dr. Nick Mast
03:06 A both-column fracture, 35 years later
06:05 Restoring the hip center in protrusio
08:46 The reverse femoral-head grafting technique
13:27 Reduce, reuse, recycle: step by step
17:29 Bilateral Crowe IV: who needs a subtroch?
19:34 Low, small, and medial — the dysplasia mantra
21:09 An SROM for ninety degrees of anteversion
24:05 Converting a failed PAO in a Perthes hip
27:05 Intrapelvic hardware from the front
29:08 Geriatric acetabular fracture: fix and replace
33:37 Bilateral Perthes, done simultaneously
35:21 The hardest call: length in unilateral Perthes
37:33 A periprosthetic fracture goes FUBAR
40:56 The foot comes out of the boot
43:59 Staying calm when the case falls apart
46:34 Pack the wound, phone a friend
48:55 Reading bad bone; the case for cement
51:39 Advice to a younger Nick Mast

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This podcast is intended for educational and informational purposes only.

The content discussed does not constitute medical advice and should not be used as a substitute for professional judgment. Clinicians should rely on their own training, experience, and clinical decision-making when applying information from this discussion.

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