Bob Handley

Dad, T&O Surgeon, BOA President, GIRFT Orthotrauma Lead, Pack Leader (dog, cat, 2 ducks & 6 hens), TMS envy, exBAS, cyclist. Views my own.

[Bob Handley @BoaHandley]

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

[Deborah Eastwood @deboraheastwood]

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

[BOA @BritOrthopaedic]

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.

[Bob Handley @BoaHandley]

@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.

[Bob Handley @BoaHandley]

@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.

[Bob Handley @BoaHandley]

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.

[Bob Handley @BoaHandley]

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.

[Jowan Penn-Barwell @MilOrthoTrauma]

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

[Bob Handley @BoaHandley]

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

[Bob Handley @BoaHandley]

@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!

[Bob Handley @BoaHandley]

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?

[Bob Handley @BoaHandley]

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

[Bob Handley @BoaHandley]

@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?”

[Bob Handley @BoaHandley]

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

[Bob Handley @BoaHandley]

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.

[Bob Handley @BoaHandley]

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

[Bob Handley @BoaHandley]

@JonMcGregorRil1 @AOUKEd @AOTrauma Of course.

[Bob Handley @BoaHandley]

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.

[Bob Handley @BoaHandley]

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.

[Bob Handley @BoaHandley]

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.