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Orthopaedic surgeons spend most of their surgical planning thinking about bones and hardware. However, respecting the soft tissues (eg, the skin) is a key factor in promoting healing after orthopaedic surgery, particularly in the setting of trauma or infection. Attending and resident physicians alike often think that they are tying square knots, when in reality they are throwing a series of half hitches in opposite directions, ultimately creating a slip knot. The purpose of this article is to review the nature of a square knot, demonstrate how to tie a square knot, and review the most common error in technique that young surgeons often demonstrate in the operating room.
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