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Current management of scaphoid fractures. Twenty questions answered
  1. N Jenkins

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    I Günal, N Barton, I Çalli, editors. London: The Royal Society of Medicine Press, 2002, £19.95, pp 110. ISBN 1-85315-518-7

    In 1992 Nicholas Barton, the author fronting this book, wrote an article, published in The Journal of Hand Surgery, reviewing the management of scaphoid fractures by considering 20 questions. In this book he presents the state of play in 2002 by posing each of those questions to nine international experts. Mr Barton’s coauthors Günal and Çalli collate the responses in the form of 20 chapters while Mr Barton summarises each chapter and adds his own opinions. The result is a very readable overview of the subject.

    The questions deal with each stage in the fracture’s management from how to make the initial diagnosis, how best to treat it, when to operate, and through to what to do when it all goes pear shaped. The book will thus be of interest to anyone who deals with this troublesome fracture in any way and therefore to all of us in A&E. It is, however, bedtime reading rather than of any use when battling on the front line.

    The review will also interest those of us who wear a managerial/clinical director’s hat and who wish our juniors to work according to pre-determined protocols, although Mr Barton and Timothy Herbert (who invented the screw of the same name), as well as others, decry the use of algorithms, stating that “Medicine is an art, not a science”. Well, for those of us who entered medicine from a scientific background and who find algorithms useful for pointing our staff in an evidence based direction, the review does allow us to re-consider our own practice. Its relevance will, of course, vary between units depending upon how many chapters’ worth each department gets involved in scaphoid management.

    I found this a useful and easy to read book. I am grateful to the EMJ for asking me to review it as I would have probably otherwise dismissed it as being of orthopaedic interest only.