Mark Phillips’ Hand Surgery Journal Digest

This journal’s Editorial is interesting. The Editor makes interesting points about why

people are so slow to change practice, mentioning ‘anchoring’ (where people tend to

take the first piece of useful information they get, and hang on to it). Publicizing your

own bad results from a technique is very rare. Changing your long held view, as a key

opinion leader, in public is also difficult and rarely happens. He also discusses ‘halo

bias’ where an impressive or well known individual’s opinion holds sway over many

others who may have a different view.

There is then a series of articles discussing the feasibility of using an intramedullary

screw to fix phalangeal fractures. The technique seems to have some merit in some

cases, but should perhaps be avoided in spiral fractures, periarticular fractures and

complex pattern fractures. I might try it!

The Editor (G E Giddins) himself publishes an article on page 696 discussing mallet

fingers with a small bony fragment. It seems that he has found that a stress X ray is

helpful in revealing how unstable the fragments are. The patient pushes the tip of the

finger into ectension as much as they can bear at the time the X ray is taken. This

results in what he calls pivoting, gliding, tilting and unstable patterns of

displacment.This may inform my own decision making in the future and I am likely to

try the technique.

The next article, from Turkey (page 701), shows that the standard extension block

wiring technique for mallet fingers is successful in most cases and the two slightly

different techniques they used were not different in effectiveness.

A trauma unit from Baltimore (page 707) have described a series of 11 ulnar

collateral injuries and 27 thumb base fractures in motorcyclists, describing a

motorcyclists version of skier’s thumb or Bennett’s fracture in 128 trauma admissions

resulting from motorcycle accidents.

On page 732 there is an interesting article from Sweden describing reduced rotational

torque in patients who have TFCC injuries and distal radioulnar instability. I had

never considered this before, but I suppose it is intuitive that this should be the case.

Screwdrivers and jar opening as well as sports with wrist twisting will be affected and

is worth taking a note of in the history.

#journal #fixmyhand #markphillips #handsurgeon

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