An orthopaedic uncertainty principle

It's not that common for orthopaedic papers to have great titles. There are exceptions though. I always like the sense of existential despair invoked by "The futility of predictive scoring of mangled lower extremities" (a good paper). Likewise, one is inevitably keen to see the X rays in "Late complications of total hip replacement from bone cement within the pelvis. A review of the literature and a case report involving dyspareunia". **

My absolute favourite though is neither peer reviewed nor 'scientific', although it's a genuinely valuable contribution to the specialty: Fergal Monsell's beautifully written "My Journey Into Uncertainty" from BJJ News in 2015, the story of his life in orthopaedics. Possibly the most humble title in any orthopaedic journal, and all surgeons need humility. Not only is it both funny and practical, it contains this gem (he's a paediatric surgeon):

I am also convinced that any operation for Perthes' Disease, DDH and slipped epiphysis is only legitimate if it does not interfere with future replacement of the hip

Terrific advice, if it means avoiding the THR in a 23 year old with a femur deformed by a 'last fling' valgising osteotomy after SUFE.





**In case you're wondering, here's the X ray. Not entirely sure where the dyspareunia came from

*

Won't somebody think of the children?

It's not that often that one finds one's orthopaedic practice stimulated by The Simpsons, but here it is:

 

 They're not just little adults are they, as the anaesthetists keep telling us that, but I have to say I think it's a bit overdone - with lots of exceptions obviously. However, the subspecialisation of paediatric orthopaedics has been extended into a lot of really pretty straightforward children's trauma. In my view this has lead to a certain amount of potentially unnecessary operating.

Twenty years ago there was actually very little quality literature on fracture remodelling. There's more now, and the oldtimers' claim that you can rely on remodelling in lots of situations seems to me to be mainly true. Again, I don't mean specific potentially problematic injuries like in late teens, displaced intra-articular fractures and so on, but there has been a tendency to overcook the interventions (personal opinion, I accept). Which I think fits with the title of this must-read paper from Nottingham. (The paper references the great Mercer Rang, one of the wittiest and best writers in the history of orthopaedics, of whom more in another post)