> ## Content Index > Fetch the complete content index at: https://www.theplasticsfella.com/llms.txt > Use this file to discover other available public pages before exploring further. # Better surgeons operate more, new journal club & the CMC joint. - URL: https://www.theplasticsfella.com/july-16th/ - Published: 2023-07-16T10:03:06.000Z - Updated: 2024-01-21T09:36:42.000Z - Description: Get insights in the "numbers game" of surgical perfection, contentious debate on mallet fractures, discover AI-melanoma, and upcoming events. - Author: PlasticsFella - Tags: thePlasticsPaper #### In this week's edition 1. ****✍️** [****Letter from P'Fella**](https://www.theplasticsfella.com/july-16th/#a-letter-from-pfella) Surgery: A Numbers Game to Perfection 2. ****πŸ€“** [****The Sunday Quiz**](https://www.theplasticsfella.com/july-16th/#the-sunday-quiz) CMCJ arthritis classification (tips to remember) 3. ****🎭**[ **New & Upcoming**](https://www.theplasticsfella.com/july-16th/#new-and-upcoming) New Educational tools and upcoming events 4. πŸ“Έ [****Image of the Week**](https://www.theplasticsfella.com/july-16th/#image-of-the-week) AI-generated nodular melanoma 5. ****🐣** [****Tweets of the Week**](https://www.theplasticsfella.com/july-16th/#tweets-of-the-week) P'Fella's 3 favourite tweets 6. πŸ€” [****Ask P'Fella**](https://www.theplasticsfella.com/july-16th/#ask-pfella) Submit & I'll answer! 7. ****πŸ“** [****Articles of the Week**](https://www.theplasticsfella.com/july-16th/#articles-of-the-week) 3 hot reads on UCLs, fractures and orthoplastics. Deep dive: should we treat mallet fingers? 8. πŸ’• [****Feedback**](https://www.theplasticsfella.com/july-16th/#feedback) Always looking to improve :) ****BTW: Have your heard the** [****deep-dive journal clubs**](https://www.theplasticsfella.com/july-16th/#articles-of-the-week) **are really good?** ## A Letter from P'Fella ### Surgery: A Numbers Game to Perfection πŸ‘‹ ****Happy Sunday,** Got a fresh spin on "practice makes perfect" for you. A study in The BMJ found that surgeons who perform more surgeries have better patient outcomes - the more we do, the better we get. Read more πŸ‘‡ Got a fresh (and evidence-based) spin on an old saying for you: practice makes perfect. But it's not just about repetition, it's about the numbers game in surgery. Intrigued? Let's get into it. A study just out in [The BMJ](https://www.bmj.com/content/381/bmj-2023-075355?ref=theplasticsfella.com) has found a fascinating link between the number of surgeries a surgeon performs and the outcomes for patients who undergo elective shoulder replacement surgery. Now, I hear you: "I'm a plastic and reconstructive surgeon, what's this got to do with me?" Stick with me here. ![](https://storage.ghost.io/c/a0/9f/a09fd7b4-d396-4b28-aed3-b87e20483292/content/images/2023/07/Screenshot-2023-07-09-at-12.19.44.png) Association of mean annual consultant volume and deviation annual consultant volume on risk of serious adverse events (30 day and 90 day). Shaded areas represent 95% confidence intervals The study found that surgeons who clocked in more than 10.4 shoulder replacements per year had better patient outcomes. We're talking lower rates of revision surgery and reoperation, fewer serious adverse events, and shorter hospital stays. The takeaway? The more surgeries a surgeon performed, the better the outcomes for their patients. So, what's the scoop for us? It's a nudge about the power of experience and the value of sharpening our skills through repetition. Whether we're talking rhinoplasty or breast reconstruction, the principle holds: the more we do, the better we get. But it's not just about us leveling up. It's about our patients leveling up, too. Shorter hospital stays and fewer adverse events mean a smoother recovery process and a better overall experience for our patients. And that's the real win, isn't it? ![](https://storage.ghost.io/c/a0/9f/a09fd7b4-d396-4b28-aed3-b87e20483292/content/images/2023/07/10-000-hours.png) [10,000 hours rule](https://pubmed.ncbi.nlm.nih.gov/24602698/?ref=theplasticsfella.com) I'm curious to hear your thoughts on this. Are you seeing a similar trend in your practice? Is there a 'magic number' of surgeries that we, as plastic and reconstructive surgeons, should be aiming for each year? Hit reply and let P'Fella in on your thoughts. Until next time, keep practicing, keep perfecting, and keep making a difference. Lots of love, P'Fella ❀️ ## The Sunday Quiz ### Classifying Osteoarthritis ****Basal thumb osteoarthritis** is the destruction of hyaline articular cartilage of the scaphoid, 1st metacarpal, trapezium, trapezoid and distal radius surface. It can be subclassified into primary (ligament laxity and attenuation over time) and secondary (trauma). ![](https://storage.ghost.io/c/a0/9f/a09fd7b4-d396-4b28-aed3-b87e20483292/content/images/2023/07/Basal-Thumb-Osteoarthritis-Definition-1.png) Reveal this week's question What stage of the Eaton classification is there widening of the trapezio-metacarpal joint? - A. Stage 1 - B. Stage 2 - C. Stage 3 - D. Stage 4 Name: Email: ## New and Upcoming ### Educational Tools, Events & Courses P'Fella spotlights impactful events, crucial webinars, and hand-picked courses we know you'll love. Also, if there's a new feature, you'll be the first to know right here. ## ![](https://storage.ghost.io/c/a0/9f/a09fd7b4-d396-4b28-aed3-b87e20483292/content/images/2023/07/eventsss.png) #### 4 Upcoming Events 1. [****World Reconstructive Microsurgery**](https://www.wsrm.net/?ref=theplasticsfella.com) \- 18th August 2. [****ASSH**](https://www.assh.org/annualmeeting/s/?ref=theplasticsfella.com) Annual Meeting - Toronto, 5th October 3. [****Plastic Surgery**](https://www.plasticsurgerythemeeting.com/?ref=theplasticsfella.com) \- The Meeting: Texas, 26th Oct 4. [****BAPRAS Congress**](http://www.bapras.org.uk/professionals/training-and-education/bapras-events/bapras-congress-2023?ref=theplasticsfella.com) \- 29th Nov ["Connect" with more Events](https://connect.theplasticsfella.com/?ref=theplasticsfella.com) ## Image of the Week ### AI-generated clinical images ![](https://storage.ghost.io/c/a0/9f/a09fd7b4-d396-4b28-aed3-b87e20483292/content/images/2023/07/melanoma-AI.png) AI-generated image: nodular melanoma ## Tweets of the Week ### Don't forget to follow [P'Fella](http://twitter.com/plasticsfella?ref=theplasticsfella.com)! > Blood gas when coming down from the summit of Everest. 😳 [#TC2023](https://twitter.com/hashtag/TC2023?src=hash&ref%5Fsrc=twsrc%5Etfw&ref=theplasticsfella.com) [@Anaes\_Trainees](https://twitter.com/Anaes%5FTrainees?ref%5Fsrc=twsrc%5Etfw&ref=theplasticsfella.com) [pic.twitter.com/yVbVMUOBMw](https://t.co/yVbVMUOBMw?ref=theplasticsfella.com) > > β€” Emily (@dr\_doddle) [July 7, 2023](https://twitter.com/dr%5Fdoddle/status/1677277941762338822?ref%5Fsrc=twsrc%5Etfw&ref=theplasticsfella.com) > I hope people’s takeaway message from recent medtwitter stories about mistakes, shortening medical school, and overall expertise is that medicine is quite difficult, actually. And we all should be campaigning for maximising training, not seeking the minimal viable product model. > > β€” Medlife Crisis (Rohin) (@MedCrisis) [July 8, 2023](https://twitter.com/MedCrisis/status/1677622251535908865?ref%5Fsrc=twsrc%5Etfw&ref=theplasticsfella.com) > 🧡regarding 'the crimp' and other technical pointers having to do with securing surgical drains with suture. > > We'll go over my preferred method, other methods like the Roman sandal, some errors people make, and other factoids. > (1/ ) [pic.twitter.com/2nTB41hOuC](https://t.co/2nTB41hOuC?ref=theplasticsfella.com) > > β€” Ron Barbosa MD FACS (@rbarbosa91) [July 6, 2023](https://twitter.com/rbarbosa91/status/1676840058631098369?ref%5Fsrc=twsrc%5Etfw&ref=theplasticsfella.com) ## Ask P'Fella ### You ask, I'll answer Every Sunday, you can ask P'Fella anything related to plastic surgery. You'll be answered the following week. Let's check out what questions came in. ❓ ****Mike's Question** How long your observe a keratoacanthoma ? ❗ ****P'Fella's Answer** Keratoacanthomas, they can be a bit of a headache. You gotta make sure the diagnosis is spot on. Mistaking them for something else might lead you to misdiagnose a high-risk skin cancer called SCC. So, these Keratoacanthomas grow pretty fast, like a few weeks fast, mainly on sun-exposed skin. You can spot them by their central crater filled with a "keratin plug". Now, if you've got a patient with a classic Keratoacanthoma, I'd schedule a follow-up in about 6 weeks. If the spot hasn't started to shrink by then, it's time to dig deeper with a biopsy for a clearer diagnosis. You might wonder, "Why not just remove it at first sight?" Well, it's not that simple. Under the microscope, Keratoacanthomas and SCCs look pretty much the same, making them hard to tell apart. So, if you remove a Keratoacanthoma thinking it's an SCC, the patient may end up with unnecessary lifelong check-ups per SCC guidelines. If you want to dive deeper into the nitty-gritty of these things, like the challenges in identifying them under the [microscope](https://pubmed.ncbi.nlm.nih.gov/20043514/?ref=theplasticsfella.com), how they [behave](https://pubmed.ncbi.nlm.nih.gov/25676096/?ref=theplasticsfella.com) over time, and when they [appear](https://www.jprasurg.com/article/S0007-1226%2804%2900157-2/fulltext?ref=theplasticsfella.com), there's plenty of reading material out there. Ask P'Fella Now 3 questions submitted in the last 24 hours... ## Articles of the Week ### 3 must-read articles, 1 deep-dive! πŸ“š #### 3 Must-reads 1. [****When is "metal" risky in finger fractures?**](https://pubmed.ncbi.nlm.nih.gov/35305847/?ref=theplasticsfella.com) Grisdela et al. Factors Associated With Implant Removal Following Plate-and-Screw Fixation of Isolated Metacarpal Fractures. J Hand Surg Am. 2023 2. [****When can I go back to sport? UCL injuries**](https://www.jhsgo.org/article/S2589-5141%2823%2900045-2/fulltext?ref=theplasticsfella.com) Allahabadi et al. Return to Play After Thumb Ulnar Collateral Ligament Injuries Managed Surgically in Athletes-A Systematic Review. J Hand Surg Glob Online. 2023 3. [****Orthoplastic protocols actually work.**](https://www.injuryjournal.com/article/S0020-1383%2823%2900576-4/fulltext?ref=theplasticsfella.com) Ylitalo et al. Implementing an orthoplastic treatment protocol for open tibia fractures reduces complication rates in tertiary trauma unit. Injury. 2023 ![](https://storage.ghost.io/c/a0/9f/a09fd7b4-d396-4b28-aed3-b87e20483292/content/images/2022/06/Deep-3.png) #### How should we treat Mallet Fingers? Uncover the intriguing journey from Mallet Finger Fractures to osteoarthritis in this riveting study! Despite a surprising twist of high OA incidence and diminished mobility post non-surgical treatment, the patient-reported outcomes surprisingly remain minimally affected - an unexpected plot twist that keeps you on the edge of your seat! [Read the deep-dive!](https://www.theplasticsfella.com/mallet-fractures-journal/) ## Feedback ### P'Fella is always looking to make this weekly newsletter as good as can be! Let me know your thoughts below :)