JTO - May 2014

01 May 2014

Volume 2 Issue 2


This issue has a Trauma focus; the next will be patient safety. We were grateful to have Nigel Rossiter from the Orthopaedic Trauma Society (OTS) as this issue’s Guest Editor. We plan to feature Guest Editors from Specialist Societies with a focus of general interest from their speciality in future. You will find the Trauma Peer-Reviewed articles on pages 60-73.

You may be wondering about the significance of the front cover image. The illustration is Barbara Hepworth’s “Prelude II” (1948), and links with the Robert Jones essay prize-winning article “A Good Pair of Hands” (page 41). Barbara Hepworth was a British abstract artist and sculptor, who formed a close affinity with Sir Norman Capener an ex BOA President from Exeter. Capener invited her to watch him operate (and based the design for Capener’s gouges on her sculpting equipment). She became fascinated by the drama of the operating theatre and visited Stanmore for further artist in residence experiences. There has recently been a Tate touring exhibition of her work “The Hospital Drawings”. In an unpublished lecture she is quoted as saying that in the orthopaedic theatre “one can observe the highest intention and purpose; one can see the most perfectly attuned movements between a group of human beings”, perhaps evidence of “Human Factor’s” training in the past? You will find another of her illustrations within the Robert Jones article. The article amplifies and updates her other observation of “a close affinity between the work and approach both of physicians and surgeons, and painters and sculptors”. We have a packed issue including an update from the Philippines (page 14), preparation for FRCS in our Trainee section (page 32) and an interesting piece on Cognitive Simulation, which fits in well with the Robert Jones article. There is some information on the Foot and Ankle syllabus for Europe from BOFAS and an update on where we are on harmonising standards of training from David Limb.

In our Medico-legal section we have part two of the Jackson Reforms article following on from the last issue (page 48) and an article focusing on the medico-legal aspects of adult tibial shaft fracture (page 56).


Colin Howie – BOA Vice President

Reference Lists


A Good Pair of Hands

1.  Obituary.  1933. Sir Robert Jones British Med J, 1, 123-5

2.  Editorial. 1957. Robert Jones 1857-1933. Journal of Bone and Joint Surgery, 39B, 179-217  

3.  MAYO W.J. 1907. Present day surgery in England and Scotland. J Minn Med Assocn, 17, 499-503   (referenced in Morrey B.F. 2005 The influence of Sir Robert Jones on the founding and development of orthopaedic surgery at the Mayo Clinic J Bone Joint Surg Br, 87-B, 106-107).

4. MCFARLAND, B. 1957. Sir Robert Jones Journal of Bone and Joint Surgery, 39B, 199-200.

5. FRAYLING, C. 2011. On Craftsmanship - towards a new Bauhaus, London, Oberon books.

6. CRAWFORD, M. 2010. The Case for Working with Your Hands: Or Why Office Work is Bad for Us and Fixing Things Feels Good, London, Penguin.

7. SENNETT, R. 2008. The Craftsman, London, Penguin.

8. HALSHAM, J. 1907. Lonewood Corner - A countryman's horizons, New York, EP Dutton and company.

9. WENGER, E. 1998. Communities of Practice. Learning, Meaning and Identitiy, New York, Cambridge University Press.

10. ISCP. 2013. Overview of the Assessment System [Online]. web: ISCP. Available: www.iscp.ac.uk/surgical/assessment_overview.aspx [Accessed 18-05-2013].

11. GRANT, J. 1999. The Incapacitating Effects of Competence: A Critique. Advances in Health Sciences Education, 4, 271-277.

12. BARNETT, R. 1994. The Limits of competence, Buckingham, The Society for Research into Higher Education and Open University Press.

13. HODGES, B. & LINGARD, L. 2012. The question of competence, New York, Cornell University Press.

14.LINGARD, L. 2009. What we see and don’t see when we look at ‘competence’: notes on a god term. Advances in Health Sciences Education, 14, 625-628.

15. FRANCIS, R. 2013. Report of the Mid Staffordshire NHS Foundation Trust Public Inquiry: Executive Summary, TSO Shop.

16.  KNEEBONE, R. 2009. Perspective: Simulation and Transformational Change: The Paradox of Expertise. Academic medicine, 84, 954-957  

17.  ZIBROWSKI, E. 2009. The sum of the parts detracts from the intended whole: competencies and in‐training assessments. Med Educ, 43, 741-748.

18. SATAVA, R. M. 2001. Metrics for objective assessment of surgical skills. Arizona: Univ Washington.

19. BRYANT, A. & CHARMAZ, K. 2007. Introduction - Grounded theory research : methods and practices. In: BRYANT, A. & CHARMAZ, K. (eds.) The SAGE Handbook of Grounded Theory. London: SAGE Publications Ltd.

20. GLASER, B. & STRAUSS, A. 1967. The discovery of Grounded Theory; Strategies for qualitative research, New York, Aldine.

21. FRIDELL K, ASPELIN P, FELLANDER-TSAI L, LUNDBERG N. 2011. The effect of PACS on the practice of orthopaedic surgeons.. J Telemed Telecare, 17(3), 137-41 

22. BRYANT, A. & CHARMAZ, K. 2007. Introduction - Grounded theory research : methods and practices. In: BRYANT, A. & CHARMAZ, K. (eds.) The SAGE Handbook of Grounded Theory. London: SAGE Publications Ltd.

23. SYED, M. 2011. Bounce – the myth of talent and the power of practice, London, Fourth Estate.

24. STEINMEYER, J. 2005. Hiding the Elephant - How magicians invented the impossible, London, Arrow Books.

25. WILSON, M. 2002. Mark Wilson's Complete Course in Magic, Philadelphia, Running Press Books.

26. BROWN, J. 2012. The Professional Opportunist, England.

27. JONES R. 1921. The Necessity of Orthopaedic Training. British Medical J, 181-186

Medico-Legal Aspects of Adult Tibial Shaft Fractures

1. Court-Brown CM, Caesar B. Epidemiology of adult fractures. Injury 2006; 37(8): 691-7 

2. Connelly CL, Bucknall V, Jenkins PJ, Court-Brown CM, McQueen MM, Biant LC. Outcome at twelve to twenty-two years of 1502 tibial shaft fractures. Bone Joint J 2014 (in press). 
3. Gaston P, Will E, McQueen MM, Elton RA, Court-Brown CM. Analysis of muscle function in the lower limb after fracture of the diaphysis of the tibia in adults. J Bone Joint Surg Br 200 82B:326-331 
4. Keating JF O’Brien PI Blachut PA, Meek RN Broekhuyse HM. Reamed interlocking intramedullary nailing of the tibia. Clin Orthop Relat Res 1997 (338): 182-91 
5. Whittle AP, Russel TA, Taylor JC, Lavelle DG. Treatment of open fractures of the tibial shaft with the use of interlocking nailing without reaming. J Bone Joint Surg Am 1992: 74 (8): 1162-71 
6. Littenberg B, Weinstein LP, McCarren M, Mead T. Swiontowski MF, Rudicel SA, Heck 1998. Closed fractures of the tibial shaft. A meta-analysis of three methods of treatment. J Bone Joint Surg Am 1998 80A:174-183 
7. McQueen MM, Christie J, Court-Brown CM. Acute compartment syndrome in tibial diaphyseal fractures. J Bone Joint Surg Br 1996 78B: 95-98 
8. Court-Brown CM, Christie J, McQueen MM. Closed intramedullary tibial nailing: its use in closed and type 1 open fractures.  J Bone Joint Surg Br 1990; 72B: 605-611 
9. Blick SS, Brumback RJ, Poka A, Burgess AR, Ebraheim NA. Compartment syndrome in open tibial fractures. J Bone Joint Surg Am 1986; 68A: 1348-1353 
10. Nicholl EA. Fractures of the tibial shaft: a survey of 705 cases. J Bone Joint Surg Br 1964; 46B: 373-387 
11. Keating JF Orfaly R O’Brien PJ. Knee pain after tibial nailing. J Orthop Trauma 1997; 11(1): 10-13 
12. Vallier HA, Cureton BA, Patterson BM. Factors influencing functional outcomes after distal tibial shaft fractures. J Orthop Trauma 2012; 26(3): 178-183 
13. Aitken RJ, Mills C, Immelman EJ. The post-phlebitic syndrome following shaft fractures of the leg: a significant late complication. J Bone Joint Surg Br 1987 69B: 775-8