Imagination does not breed insanity. Exactly what does breed insanity is reason. (G K Chesterton)
Sunday, March 26, 2017
Sunday, February 26, 2017
Sunday, February 5, 2017
Sunday, January 8, 2017
Elephant
"We have to remember that what we observe is not nature in itself, but nature exposed to our method of questioning."
Werner Heisenberg
They were laughing again.
The boy craned his neck over the sea of turbaned heads.
In the middle was a patch of dirt and an elephant. Around the elephant sat four blind men with the look of deep concentration that only blind men bring to bear. One man felt her trunk, another her tail, yet another her ear, and the fourth her leg. The elephant was calm with her keeper standing close by. She let out what seemed to be a yawn.
“I know!” cried the blind man holding the tail. He allowed a short pause for effect. “It’s a rope,” he pronounced with satisfaction. The crowd roared out with laughter.
“Actually it’s more like a hose,” said the man stroking the elephant’s trunk. “No wait..” he paused, as if he could sense ridicule waiting to burst forth, “it.. it is a tubular structure.. It must be a conduit of some kind. A hose. Yes, a hose.”
“It can’t be,” interjected the man stroking the elephant’s ear, “it is a giant fan. It’s not like a rope at all.”
The crowd jeered and threw stones.
The crowd jeered and threw stones.
The blind man stroking the elephant’s leg remained quiet. He then asked the elephant’s keeper if he could lead him to the man holding the elephant’s ear. He whispered to the other blind man and stroked the elephant’s ear. He then went to the man holding the elephant’s trunk. And then to the man holding the elephant’s tail. The blind man then returned to his place and sat down, stroking the elephant's leg.
“Is it still a tree trunk?” shouted a man from the crowd.
The blind man didn’t answer. “Well, if it is a tree, it is a very strange tree indeed.” he said finally.
The boy scrambled back to his seat. He brushed past a man crooked with age throwing him off balance. The old man was blind. “I’m terribly sorry,” said the boy as he helped right the old man. “That’s ok,” he replied feeling out for his cane. The boy picked up the cane and placed it into the old man’s hand. “Thank you,” said the old man. The boy looked at the old man. “Do you know the men sitting around the elephant?” he asked.
The old man smiled. “No,” he replied. The boy looked at the old, blind man and felt sorry for him. He looked at his bent back, the blotches and deep furrows over his face, his thin wispy hair, the eyes that could not see.
The crowd laughed and clapped their hands.
“Tell me what you see,” said the old man.
“I see an elephant,” replied the boy. “Ahhh..” the old man nodded, “describe it to me.” “Well,” the boy replied, “it has a tail like a rope; a nose shaped like a long hose; these big ears like giant fans; and four strong legs like tree trunks planted in the ground.” The boy continued, “But it’s not any of these things. It’s all of them and none of them.. It’s an elephant.”
The old man smiled again and nodded his head.
“Have you ever seen an elephant?” asked the boy.
“Yes,” replied the old man, “Many years ago. When I was young boy like yourself.” He continued, “My eyes could see back then.”
The boy looked at the old man. “Why did you come here?” he asked.
“To remind myself that the human conscious state explores its environment with five senses in three dimensions..” replied the old man, “.. And the possibility that you are right about the elephant.”
The boy scratched his head.
The old man grinned with mischief. “No. Not really,” he said. “I’m waiting for my daughter to pick me up.”
The boy smiled and touched the old man’s arm. “I hope she won’t be too long,” he said and took his leave.
Tuesday, December 27, 2016
Sunday, December 4, 2016
Percutaneous reduction and fixation of the flexed fractured scaphoid
Here’s a neat technique..
17yo male with scaphoid waist fracture
CT reveals comminution
And a humpback deformity
You get the impression there is a pre-existing bone cyst through which the fracture occurred
Lunate extension secondary to scaphoid flexion
This is not the typical case for percutaneous fixation but:
1. a Matti-Russe approach and fixation with screws or a scaphoid plate is not without its problems
2. there is good evidence that stable fixation can obviate the need for bone grafting
3. ask yourself “Can this be done better?”
Well, maybe..
Traction applied
K wire is passed through the lunate
Lunate flexed relative to RCJ (extending scaphoid at the fracture site)
Two guide-wires passed across the fracture site
Scapholunate angle corrected on lateral view
Percutaneous screws
Lateral view to confirm acceptable SLA
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