Bob Handley

Chris Moran OBE. It has certainly been earned. Thank you for the efforts on all our behalves.

Hard hitting meeting with the Presidents of the RCS of England and Edinburgh - trying to find ways to help our patients, surgeons and trainees.. no magic wand but undeniably a willingness to continue to work together..@BritOrthopaedic @rjhgregory @bota_uk @PRCSEd @mortensen_neil

New BOA statement* BOA welcomes extra £1bn for England elective care backlog, but concerned this will not go far enough to deal with enormity of waiting list. #Orthopaedics has biggest wait list and situation is intolerable for many patients.

@xlgriffin @deepamusafir1 @Drlyndonmason @FameTrial @InvictaOrtho @GurdipChahal4 @LRSsurgeon @footankle @GermanMenRev @nibrassalim2 @raju_ahluwalia @YrkshrFootAnkle @OTrauma @Williameardley @OrthohubXYZ @BOFAS_UK @RCSnews The prospect of widespread monitoring of outcome is interesting. If I were a patient I would be much more interested in outcomes related to diagnoses than specific interventions. The problem is that an intervention is an easier starting point.

@deepamusafir1 @Drlyndonmason @FameTrial @InvictaOrtho @GurdipChahal4 @LRSsurgeon @footankle @GermanMenRev @nibrassalim2 @raju_ahluwalia @YrkshrFootAnkle @BoaHandley @OTrauma @Williameardley @OrthohubXYZ @BOFAS_UK @RCSnews hopefully will have something to report soon!

Fun thread: ankle# common & remains controversial AIM trial reports: jamanetwork.com/journals/jama/… jamanetwork.com/journals/jama/… Headlines @ 3 yrs - CCC vs ORIF Equiv function OMAS diff =-0.6(-3.9,2.6) Mean OR visits per pt 1.3 vs 1.2 Mean time to WB 3 weeks both groups Now: @FameTrial

@hand_specialist @InvictaOrtho @valehandsurgery @richierich356 I think they are different. My interpretation is an anti-glide acts at the apex and a buttress remote from the apex. Therefore a buttress plate needs to be stronger whilst an anti-glide can be quite delicate.

@InvictaOrtho @valehandsurgery @richierich356 I was taught buttress for intra articular and anti glide for diaphyseal fractures. @BoaHandley can you shed any light?

This picture by Stefan Perren of stress lines tells much. The plastic is elastically deformed, is storing energy and shows preload. If screw overtightened the plastic then plastically deforms, fails, no more preload. How much do you tighten a screw in bone? 80% of failure torque.

How much do you tighten a screw? Initially as a screw is turned it advances but when progress is arrested turning takes more effort and it “tightens”; the components of the construct deform. As long as deformation is elastic the energy is stored and the construct is preloaded.

Amazing #OpenAccess resource from the Fragility Fracture Network. @BritOrthopaedic @britishtrauma

Preloading; some now take this to mean consuming cheap alcohol at home to save expense on a night out. However, for the benefit of the patient it is better that a T&O surgeon thinks of it as storing potential energy in a mechanical construct for greater stability and durability

@JosephAlsousou With a Newton’s cradle however much little energy is in a single impact ball only a single ball moves at the other end of the group. Hammer size is worthy of more study. Sculptors must know the answer, else many statues would have no noses!

@BoaHandley Agreed, size does have an effect but also the force used will change the energy as per Einstein theory. The tiniest object in the universe can mot reach speed of light because their mass becomes infinite😉 use the right size and know how to use it I would say 🧐

What size hammer? A Newton’s cradle or billiards shows us tidy and almost complete transfer of energy if colliding elastic objects are equal. Why then in theatre do we tend to use one size of mallet to for all tasks in the vain hope that "skill" can defy the laws of physics?

@JosephAlsousou Size matters! Hammer too small; it bounces back. Hammer too big; it follows through. Goldilocks hammer; best transfer of energy. Simples!

@BoaHandley Is it about the size or how to use it? By Newton laws too, using one size hammer with varying force will lead to various transfer of energy

@rjhgregory So am I to say to the patient “I am sorry that we could not save your leg, but the team pulled together to produce this impressionist momento of your absent limb?”

16/365 Reduction 2. Intuitive to a child is that if you have a multi-fragmentary pig it is best to view the big picture and build a frame of reference (the straight edged pieces). The necessary alignment of snout and trotter is then achieved even if pieces are missing or unplaced

17/365 Ponseti for ducks. Angel wing is a deformity which results in the wing protruding laterally when at rest and folded, it can prevent flight. Thought to result from excess protein in diet. Merry (his colleague is Pippin) was afflicted. 36 hours of strapping resolved issue.

@JonMcGregorRil1 @AOUKEd @AOTrauma Porky (the pig) and Bertie (the bee on his nose) would be delighted in your interest!

@JonMcGregorRil1 @AOUKEd @AOTrauma Of course.

14/365 You are never too young to learn the concepts of fracture reduction. I knew that precise repositioning of the fragments would reconstitute “Porky” even if I did not look at the picture itself. “Direct reduction techniques for the preschool child” a potential bestseller.

For an orthopaedic surgeon “Measure twice cut once” is a sound concept. It may be added that ideally it should be done it in that sequence. Otherwise it is like re-reading the reviews after a rushed purchase in order to rationalise and defend a potentially shaky decision.

13/365 “Unless you are very lucky you only find what you look for”, an adage in a radiology textbook. True of diagnoses, gorillas with basketball players and Upland geese. After a walk in the Falklands I was asked how many sitting geese I had seen; I was sorry proof of the adage.