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When Should I Try Something New?

By Michael M. Vosbikian, MD

This is a question that plagues us all whenever we read an article, see something at a meeting, or get approached by someone from industry. We see the technique or the technology, we get seduced, and all of a sudden, to this shiny new hammer, everything looks like a nail. That is all well and good until the reality sets in and follow up humbles you with the truth that there is a learning curve to anything new, a curve that carries consequences.

For me, this was fragment specific fixation for complex distal radius fractures. After seeing this technique presented at a meeting, I thought it made so much sense, why wouldn’t I do it? There are fragments, they are specific, and I can fix them. But I came back to my practice and asked myself, “if it is so great, why isn’t everyone doing it?” Paraphrasing something that one of our wisest attendings would say to us in training, “Before you try something new, ask yourself, what problem am I solving? If there is no problem, it’s not the solution.”

Reflecting on this, the problem wasn’t failure of fixation. It wasn’t articular reduction. The problem, where I practice, was the need for second surgeries and patients coming back for them. Oftentimes, we face challenges of loss to follow-up with patients who have dorsal spanning plates or volar plates that cross the watershed line by design. They return for flexor issues or broken hardware and not their staged removal. Here was the problem, but did the technique pose a solution?

I would argue yes. This technique would allow capture of those small fragments in many cases. It would allow earlier motion. It would prevent a return to the operating room, and more importantly for the patient, it would prevent the sequelae of the retention of that hardware, particularly if compliance is an issue. As with anything, the complications must also be considered. It is a larger surgery with more soft tissue dissection, but I think in these patients the benefits outweigh the risks.

Now, I am not saying that every one of these cases is a home run. No technique can guarantee that. Nor am I saying that it’s right for everyone’s practice. To tout these things would be a deception to not only our patients but to myself, our residents, fellows, and colleagues. Yet, for me this has been a very useful tool in the armamentarium, and as we understand it better and evolve, there is a place for this technique.

I encourage you to see new things, get excited about them, but realize that to a hammer, not everything is a nail. Go back and reflect on the question asked to many of us by Dr. Rothman over the years, “what problem am I solving?” If you can honestly reflect on your patients and practice and execute the techniques and principles, you may have found the right nail for that hammer.

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