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

RT @deboraheastwood: Hard hitting meeting with the Presidents of the RCS of England and Edinburgh - trying to find ways to help our patient…

RT @BritOrthopaedic: New BOA statement* BOA welcomes extra £1bn for England elective care backlog, but concerned this will not go far eno…

@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.

@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.

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.

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.

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

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

@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!

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

@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?”

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.

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

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.

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.

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.