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.