{"id":77,"date":"2014-01-25T08:24:23","date_gmt":"2014-01-25T13:24:23","guid":{"rendered":"http:\/\/www.bluzeus.com\/orthoblog\/?p=77"},"modified":"2014-01-25T08:25:33","modified_gmt":"2014-01-25T13:25:33","slug":"a-triumph-of-matter-over-mind","status":"publish","type":"post","link":"https:\/\/www.orthopaediclist.com\/blog\/a-triumph-of-matter-over-mind\/","title":{"rendered":"A Triumph of Matter over Mind"},"content":{"rendered":"
\n

by Augusto Sarmiento, MD<\/p>\n

January 25, 2014<\/p>\n

The current pervasive and misguided infatuation with the idea that in the care of fractures it is indispensable to achieve perfect restoration of anatomy in all instances in order to obtain good clinical results continues to blind many in our profession. I have previously made reference to this obsession suggesting that we train our residents to be cosmetic surgeons of the skeleton rather than physicians\/scientists1<\/sup>.<\/p>\n

My belief that Orthopaedics is losing its scientific primacy and rapidly becoming an entirely technical discipline was reinforced a short time ago when I learned of a clinical situation where passion prevailed over reason with very likely adverse serious consequences.<\/p>\n

The clinical case consisted of a 21 year old man who was involved in automobile accident rendering him paraplegic. In addition he had suffered bilateral comminuted, distal intraarticular fracture of both forearms. The fractures were treated by means of internal fixation using plates and screws as well as multiple pins that held together the diligently repositioned small fragment. Radiographs obtained following surgery demonstrating excellent reduction of the fractures.<\/p>\n

For reasons not known to me, the surgeon chose to improve upon the fixation achieved from the plates and screws by placing on the dorsum of the patient\u2019s right arm a long plate that extended from the neck of the third metacarpal to the mid-radius. Several screws filled the holes in the long plate. This plate, I was told, would be removed six weeks after surgery; therefore I assumed it was not intended to encourage fusion of the wrist.<\/p>\n

I cannot express strong disagreement with the procedure performed for the care of the radius fractures that must have taken a great deal of time plus the likely possibility that the extensive dissection of the bony fragments could result in major stiffness of his wrists joints. After all this is the current party line. However, I cannot help but question the wisdom of inserting a plate that inevitably will increase the degree of limitation of motion of the wrist from which the patient will never completely recovered.<\/p>\n

This very realistic scenario provokes an even greater discomfiture when one realizes that the young man was paraplegic and will remain paraplegic for the rest of his days. As such, his only mode of locomotion will be a wheel chair, from which he will transfer to his bed and automobiles. A bit of thought should have made the surgeon aware that transfer activities from a wheel chair require a significant degree of dorsiflexion of the wrists. In order to lift one\u2019s body with the use of the hands, dorsiflexion of the wrists is essential. The young man, I anticipate, will not be able to do so, and if he masters s technique to accomplish the task it will be a very complicated and difficult one.<\/p>\n

I have surmised that the surgeon performing the surgery was very likely a technically skillful one, but either because of his blind reliance on the virtues of internal fixation and perfect reapproximation of fragments, or lack of objectivity, he has condemned a young man to a disability greater than the one that the paraplegia had already imposed on him.2<\/sup>. It does not suffice to adhere to the aphorism expressed by Simon Bolivar, the Latin American liberator, \u201cGood judgment comes from experience and experience comes from bad judgment\u201d, at least not when we are dealing with the health and future of other human beings.<\/p>\n

The rampant lack of objectivity, clearly demonstrated in this instance, can be improved if we, the educators, emphasize objective reasoning to our students. Unharnessed enthusiasm and fascination with surgical experiences must be tempered with reason. \u201cLa raison avant la passion\u201d.<\/p>\n

REFERENCES:<\/p>\n

1.\u00a0\u00a0 Sarmiento A. The future of our specialty. Acta Orthopedica Scandinavica. 71 (6): 574-579, 2000<\/p>\n

2.\u00a0\u00a0 Sarmiento A. Have we lost Objectivity?\u00a0 Jour. Bone and Joint Surgery. Vol. 84A:\u00a0 1254-58, 2002.<\/p>\n

Dr. Sarmiento is the former Professor and Chairman of Orthopaedics at the Universities of Miami and Southern California, and past-president of the American Academy of Orthopaedic Surgeons<\/a>.\u00a0 He is a contributor to\u00a0Implant Identification<\/a> on OrthopaedicList.com<\/a>\u00a0and has guest authored a number of other articles for this blog.<\/em><\/p>\n<\/div>\n","protected":false},"excerpt":{"rendered":"

by Augusto Sarmiento, MD January 25, 2014 The current pervasive and misguided infatuation with the idea that in the care of fractures it is indispensable to achieve perfect restoration of anatomy in all instances in order to obtain good clinical results continues to blind many in our profession. I have previously made reference to this […]<\/p>\n","protected":false},"author":2,"featured_media":0,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[5],"tags":[],"yoast_head":"\nA Triumph of Matter over Mind - OrthopaedicLIST.com Blog<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/www.orthopaediclist.com\/blog\/a-triumph-of-matter-over-mind\/\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"A Triumph of Matter over Mind - OrthopaedicLIST.com Blog\" \/>\n<meta property=\"og:description\" content=\"by Augusto Sarmiento, MD January 25, 2014 The current pervasive and misguided infatuation with the idea that in the care of fractures it is indispensable to achieve perfect restoration of anatomy in all instances in order to obtain good clinical results continues to blind many in our profession. I have previously made reference to this […]\" \/>\n<meta property=\"og:url\" content=\"https:\/\/www.orthopaediclist.com\/blog\/a-triumph-of-matter-over-mind\/\" \/>\n<meta property=\"og:site_name\" content=\"OrthopaedicLIST.com Blog\" \/>\n<meta property=\"article:published_time\" content=\"2014-01-25T13:24:23+00:00\" \/>\n<meta property=\"article:modified_time\" content=\"2014-01-25T13:25:33+00:00\" \/>\n<meta name=\"author\" content=\"James Hundley, MD\" \/>\n<meta name=\"twitter:card\" content=\"summary_large_image\" \/>\n<meta name=\"twitter:label1\" content=\"Written by\" \/>\n\t<meta name=\"twitter:data1\" content=\"James Hundley, MD\" \/>\n\t<meta name=\"twitter:label2\" content=\"Est. reading time\" \/>\n\t<meta name=\"twitter:data2\" content=\"3 minutes\" \/>\n<script type=\"application\/ld+json\" class=\"yoast-schema-graph\">{\"@context\":\"https:\/\/schema.org\",\"@graph\":[{\"@type\":\"WebPage\",\"@id\":\"https:\/\/www.orthopaediclist.com\/blog\/a-triumph-of-matter-over-mind\/\",\"url\":\"https:\/\/www.orthopaediclist.com\/blog\/a-triumph-of-matter-over-mind\/\",\"name\":\"A Triumph of Matter over Mind - OrthopaedicLIST.com Blog\",\"isPartOf\":{\"@id\":\"https:\/\/www.orthopaediclist.com\/blog\/#website\"},\"datePublished\":\"2014-01-25T13:24:23+00:00\",\"dateModified\":\"2014-01-25T13:25:33+00:00\",\"author\":{\"@id\":\"https:\/\/www.orthopaediclist.com\/blog\/#\/schema\/person\/87a719b32f490b91a2f4a6a44d4d6752\"},\"breadcrumb\":{\"@id\":\"https:\/\/www.orthopaediclist.com\/blog\/a-triumph-of-matter-over-mind\/#breadcrumb\"},\"inLanguage\":\"en-US\",\"potentialAction\":[{\"@type\":\"ReadAction\",\"target\":[\"https:\/\/www.orthopaediclist.com\/blog\/a-triumph-of-matter-over-mind\/\"]}]},{\"@type\":\"BreadcrumbList\",\"@id\":\"https:\/\/www.orthopaediclist.com\/blog\/a-triumph-of-matter-over-mind\/#breadcrumb\",\"itemListElement\":[{\"@type\":\"ListItem\",\"position\":1,\"name\":\"Home\",\"item\":\"https:\/\/www.orthopaediclist.com\/blog\/\"},{\"@type\":\"ListItem\",\"position\":2,\"name\":\"A Triumph of Matter over Mind\"}]},{\"@type\":\"WebSite\",\"@id\":\"https:\/\/www.orthopaediclist.com\/blog\/#website\",\"url\":\"https:\/\/www.orthopaediclist.com\/blog\/\",\"name\":\"OrthopaedicLIST.com Blog\",\"description\":\"News About Orthopaedic Surgery and Orthopaedic Products and Services\",\"potentialAction\":[{\"@type\":\"SearchAction\",\"target\":{\"@type\":\"EntryPoint\",\"urlTemplate\":\"https:\/\/www.orthopaediclist.com\/blog\/?s={search_term_string}\"},\"query-input\":{\"@type\":\"PropertyValueSpecification\",\"valueRequired\":true,\"valueName\":\"search_term_string\"}}],\"inLanguage\":\"en-US\"},{\"@type\":\"Person\",\"@id\":\"https:\/\/www.orthopaediclist.com\/blog\/#\/schema\/person\/87a719b32f490b91a2f4a6a44d4d6752\",\"name\":\"James Hundley, MD\",\"image\":{\"@type\":\"ImageObject\",\"inLanguage\":\"en-US\",\"@id\":\"https:\/\/www.orthopaediclist.com\/blog\/#\/schema\/person\/image\/\",\"url\":\"https:\/\/secure.gravatar.com\/avatar\/210425b5d38259409c4acb9bbb1e31bf?s=96&d=mm&r=g\",\"contentUrl\":\"https:\/\/secure.gravatar.com\/avatar\/210425b5d38259409c4acb9bbb1e31bf?s=96&d=mm&r=g\",\"caption\":\"James Hundley, MD\"},\"description\":\"Dr. Hundley is a retired orthopaedic surgeon and the originator and co-founder of OrthopaedicLIST.com, a resource website for orthopaedic surgeons and related professionals.\",\"sameAs\":[\"http:\/\/www.orthopaediclist.com\"],\"url\":\"https:\/\/www.orthopaediclist.com\/blog\/author\/hundleysr\/\"}]}<\/script>\n<!-- \/ Yoast SEO plugin. -->","yoast_head_json":{"title":"A Triumph of Matter over Mind - OrthopaedicLIST.com Blog","robots":{"index":"index","follow":"follow","max-snippet":"max-snippet:-1","max-image-preview":"max-image-preview:large","max-video-preview":"max-video-preview:-1"},"canonical":"https:\/\/www.orthopaediclist.com\/blog\/a-triumph-of-matter-over-mind\/","og_locale":"en_US","og_type":"article","og_title":"A Triumph of Matter over Mind - OrthopaedicLIST.com Blog","og_description":"by Augusto Sarmiento, MD January 25, 2014 The current pervasive and misguided infatuation with the idea that in the care of fractures it is indispensable to achieve perfect restoration of anatomy in all instances in order to obtain good clinical results continues to blind many in our profession. I have previously made reference to this […]","og_url":"https:\/\/www.orthopaediclist.com\/blog\/a-triumph-of-matter-over-mind\/","og_site_name":"OrthopaedicLIST.com Blog","article_published_time":"2014-01-25T13:24:23+00:00","article_modified_time":"2014-01-25T13:25:33+00:00","author":"James Hundley, MD","twitter_card":"summary_large_image","twitter_misc":{"Written by":"James Hundley, MD","Est. reading time":"3 minutes"},"schema":{"@context":"https:\/\/schema.org","@graph":[{"@type":"WebPage","@id":"https:\/\/www.orthopaediclist.com\/blog\/a-triumph-of-matter-over-mind\/","url":"https:\/\/www.orthopaediclist.com\/blog\/a-triumph-of-matter-over-mind\/","name":"A Triumph of Matter over Mind - OrthopaedicLIST.com Blog","isPartOf":{"@id":"https:\/\/www.orthopaediclist.com\/blog\/#website"},"datePublished":"2014-01-25T13:24:23+00:00","dateModified":"2014-01-25T13:25:33+00:00","author":{"@id":"https:\/\/www.orthopaediclist.com\/blog\/#\/schema\/person\/87a719b32f490b91a2f4a6a44d4d6752"},"breadcrumb":{"@id":"https:\/\/www.orthopaediclist.com\/blog\/a-triumph-of-matter-over-mind\/#breadcrumb"},"inLanguage":"en-US","potentialAction":[{"@type":"ReadAction","target":["https:\/\/www.orthopaediclist.com\/blog\/a-triumph-of-matter-over-mind\/"]}]},{"@type":"BreadcrumbList","@id":"https:\/\/www.orthopaediclist.com\/blog\/a-triumph-of-matter-over-mind\/#breadcrumb","itemListElement":[{"@type":"ListItem","position":1,"name":"Home","item":"https:\/\/www.orthopaediclist.com\/blog\/"},{"@type":"ListItem","position":2,"name":"A Triumph of Matter over Mind"}]},{"@type":"WebSite","@id":"https:\/\/www.orthopaediclist.com\/blog\/#website","url":"https:\/\/www.orthopaediclist.com\/blog\/","name":"OrthopaedicLIST.com Blog","description":"News About Orthopaedic Surgery and Orthopaedic Products and Services","potentialAction":[{"@type":"SearchAction","target":{"@type":"EntryPoint","urlTemplate":"https:\/\/www.orthopaediclist.com\/blog\/?s={search_term_string}"},"query-input":{"@type":"PropertyValueSpecification","valueRequired":true,"valueName":"search_term_string"}}],"inLanguage":"en-US"},{"@type":"Person","@id":"https:\/\/www.orthopaediclist.com\/blog\/#\/schema\/person\/87a719b32f490b91a2f4a6a44d4d6752","name":"James Hundley, MD","image":{"@type":"ImageObject","inLanguage":"en-US","@id":"https:\/\/www.orthopaediclist.com\/blog\/#\/schema\/person\/image\/","url":"https:\/\/secure.gravatar.com\/avatar\/210425b5d38259409c4acb9bbb1e31bf?s=96&d=mm&r=g","contentUrl":"https:\/\/secure.gravatar.com\/avatar\/210425b5d38259409c4acb9bbb1e31bf?s=96&d=mm&r=g","caption":"James Hundley, MD"},"description":"Dr. Hundley is a retired orthopaedic surgeon and the originator and co-founder of OrthopaedicLIST.com, a resource website for orthopaedic surgeons and related professionals.","sameAs":["http:\/\/www.orthopaediclist.com"],"url":"https:\/\/www.orthopaediclist.com\/blog\/author\/hundleysr\/"}]}},"_links":{"self":[{"href":"https:\/\/www.orthopaediclist.com\/blog\/wp-json\/wp\/v2\/posts\/77"}],"collection":[{"href":"https:\/\/www.orthopaediclist.com\/blog\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/www.orthopaediclist.com\/blog\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/www.orthopaediclist.com\/blog\/wp-json\/wp\/v2\/users\/2"}],"replies":[{"embeddable":true,"href":"https:\/\/www.orthopaediclist.com\/blog\/wp-json\/wp\/v2\/comments?post=77"}],"version-history":[{"count":3,"href":"https:\/\/www.orthopaediclist.com\/blog\/wp-json\/wp\/v2\/posts\/77\/revisions"}],"predecessor-version":[{"id":80,"href":"https:\/\/www.orthopaediclist.com\/blog\/wp-json\/wp\/v2\/posts\/77\/revisions\/80"}],"wp:attachment":[{"href":"https:\/\/www.orthopaediclist.com\/blog\/wp-json\/wp\/v2\/media?parent=77"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/www.orthopaediclist.com\/blog\/wp-json\/wp\/v2\/categories?post=77"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/www.orthopaediclist.com\/blog\/wp-json\/wp\/v2\/tags?post=77"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}