The Schedule for the Year 2009

The meeting date is the third Tuesday of the month and the time is 7:00 pm for food and cases. Noah has observed that we either have to start the Journal (ie, end cases) by 8:30 pm or change the name to Cases Club. Late-comers will be requested to save their cases to after Journal Club. If you are the host, bring a view box. If you do not have one, let David know at least one day in advance and he will bring the Jay Hann-VA Viewbox. If you cannot attend, please email the host at least a day in advance, as this helps them to plan the food. If less than 24 hrs, please call.

November was hosted by Rebecca at her home. Present were Monty, John, Bob, Bill, Charlotte, Relton, Mat, David and Rebecca. Cheese and wine was followed by a feast of roast lamb, couscou with currants, and salad. Dessert was marinated strawberries and ice cream. Our newest member, John, duly brought chocolate cake, but David was studying for a blood test in the am for life insurance and could not eat fatty foods. (Rebecca thoughtfully sent him home with a chocolate cake care package. Thank you, Rebecca). We discussed cases and finally moved to the October journal. John gets the bon mot award for saying that operating on the extensor tendon over P2 is like "tickling the belly of a tiger" since you always get mauled. We all liked Peter Stern's article on the hemihamate arthroplasty for PIP's and at least David felt that the article on medical websites was good in that it looked at medical education via websites, but that both the AAOS and the ASSH webpages examined were "book dumps" (scanning a printed page and thinking you are using the power of the net), and failed to use full color, any photographs, any xrays, any video, and the text was minimalist and boring. Next: October issue at Bill's home; Bob has January.

October was hosted by David at the Webster Surgery Center. Present were Bob, Charlotte, Monty, Relton, Kendrick, Noah, Doug, Mat, and David. The evening started with cheeses (Parmigiano reggiano, a very soft European bleu, and a goat bleu), wonderfully complimented by wines provided by the generoisty of Bil, recently back from a tour of Turkey, Greece, and the Adriatic: 2004 Chambolle-Musigny Premier Cre Francois Bertheau, 2007 Copain "Tous Ensemble" Pinot Noir Alexander Valley, 2005 Tudor Pinot Noir Santa Lucia Highlands, and then a 2005 Gigondas Domaine Les Pallieres. Next was a hearts of Romaine salad with croutons, grated parmigian, and a dark balsamic dressing. Around this time Monte discovered that we were not at 80 Grand and joined us. The entre was grilled salmon, served hot off the flames of the microwave with a rosemary butter sauce, grilled asparagus, and a rice with currant and mango. The salmon was not served with lemon slices, because David forgot them on the sideboard. Chocolate cake finished the meal. Vigorous case discussion was had throughout, with Relton demonstrating that he could predict what everyone would say regarding a case of a reducible, static scapholunate dissociation. Are we that predictable? The technology of the moment was highlighted by Noah, who wanted to show a case he had just completed but only had images on his cell phone. Barely pausing in his presentation, he emailed them to Kendrick, who was far across the room. Kendrick then displayed the images on his laptop for the group to see, as Noah continued with his presentation. What are we coming to? 15 minute followup documented on the web! Can YouTube be far behind? We all enjoyed the techical alacrity shown by Noah and Kendrick. The JN was rather lax. Despite bludgeoning various and sundry into quieting simultaneous conversations (forbidden by the Constitution), we only got to page 1215. When David asked if we were on schedule enough to skip December, the only reply was from Bill, who said, "I'll host." There being no nay votes, the meeting was adjourned until November 17 at Becky's, with Bill to do December 15.

September was hosted by Doug at the Webster Surgery Center, due to a lack of any furniture at his house.  Present were Charlotte, Rebecca, Relton, Kendrick, John, David, and Doug. The food was, well, hard to describe. Eclectic?  It was delicious, ranging from salami and cheese as starters, dinner was ribs & corn & salad, with select imported beers in addition to some wine. Chocolate cake was served, but the fruit torte seemed to be more popular. Coffee was delicious although Doug is mechancially challenged. An updated Address list was created. The group agreed to try to tone down simultaneous conversations and to be courteous so that each surgeon who needed advice got enough information so that they could proceed. Few cases were presented so we launched into the Journal. Some were suspicious that the Journal of Obscure Statistics had been substituted for the Journal of Hand Surgery, but after discovering that Decision Analysis was going to be as useful as Outcomes Research, we all decided to skip the first three articles and move on to something we could understand. Trigger finger cost analysis was the apex (nadir?) of the evening; at least we understood it, it was relevant to the practice of hand surgery (and agreed with our already-formed opinions): two shots, then the knife.

August was hosted by Mat and Nancy, and we had the usual feast that was very well prepared. Wine and cheese accompanied the conversation in the kitchen, with Bob, Bill, Charlotte, Doug, Noah, Kendrick, Relton, and David. The dinner was roast beef, pasta, and salad with shrimp. Cases were discussed, but with a bit more than normal chaos. Finally, as we dipped into strawberries, shortcake, and chocolate cake, we tried to start the Journal. Little found much interest and we did a rather poor job of covering the issue. We need someone to volunteer for October; Bill said he wanted to host something.

July was hosted with style by Relton. He cooked up a delicious dish of lamb shoulder with noodles and many of us went back for seconds. It was accompanied by a 1974 Cabernet, beans (from Relton's garden?) and a delicious salad with all sorts of ingredients. John again documented his value to the group by bringing a chocolate cake for dessert (as well as an anatomic discussion why preserving both slips of the FDS had value). Present were Monty, Charlotte, John, Mat, Kendrick, Noah, and David, with a cameo appearance by Bill Newmeyer. There were few cases to discuss, so we have no justification for starting the Journal at 9. David, as always, wanted to talk about how little pain the patients have after surgery, to which John replied, "Why do you want them to not have pain?" While I believe he was referring to the Gift that Nobody Wants (he went on to describe some of the problems pain-deficient patients have), members of the International Society for the Study of Pain (Nelson is a member) would be shocked at such a question. Fertile ground for further discussion, which led to Hagert's paper (p 642) on the innervation of the wrist ligaments and her PhD thesis on wrist reflex arcs. Szabo's paper on distraction osteogenesis (p 617) was soundly dissed; Relton asked, "Why would anyone in their right mind want to do such a procedure, when there is a 300% complication rate and a much simpler alternative (ulnar shortening osteotomy)?" Fluoroscopy of Bennett's fracture (p 637) was greeted by a consensus that open reduction allowed a better visualization than closed management. The Workstyle paper (p724) merely reinforced our J Club's common comment that the patient, not the procedure, predicts return to work. Did I miss any highlights? Next up: Mat will host August, Doug will do September, and we need volunteers for the rest of the year.

June was hosted by Bob Hoffman, who served up roast lamb, baked zucchini, and couscous. Dessert was again provided by John and was delicious (he only gets 1/2 credit, though, because 1/2 of the cake was vanilla!) Present were Bill, John, Rebecca, Charlotte, Mat, Relton, and David. Cases were discussed, lively and spirited as always. And as always, David wanted to discuss distal radius fractures (if the ulna seems floppy but not frankly unstable, examine the other side) and John wanted to know who did endo vs open CTR's. There seemed to be a consensus that four-corner fusions are helped by scaphoid excision, that vascularized bone grafts to the scaphoid might be reserved for AVN documented intraop (even if predicted by MRI pre-op), and that the usual suspects do ganglionectomies endoscopically and ditto for those that do them open; none of our assembled arthroscopists (Rebecca and Mat) find the kind and frequency of SL instabilities as found by Edwards, et al. Ulnar heads of silastic may result in less damage to the cartilage of the sigmoid notch but it remains to be seen in clinical studies if silicone synovitis will offset any such advantage. The article on nonsurgical treatment of CTS may represent another nadir in the pantheon of evidence-based medicine (no study was long-term enough to show that nonoperative treatment was effective in changing the long-term outcome), and endo vs open CTR remains at a standoff: both work well in the right hands. Even John does WC CTR open, so no one can complain later that there was an incomplete release.

May was hosted by Bill, who as usual did it with style. Present were Bob, Monty, Doug, Relton, John, David, Kendrick, Charlotte, Mat, Noah, and Bill. Cases were discussed with the usual vigor and chaos. The dinner was barbequed halibut with a rosemary sauce, accompanied by aparagus wrapped with proscuitto, all grilled by Bill's nephew as the guest chef. The wonderful dinner was followed by a course of basmati rice, which had been forgotten on the stove. Dessert was a doubly chocolate cake kindly supplied by John:

Dessert and coffee were followed by a review of the Journal, which was started in the standard tardy fashion. It required Noah's scolding of the JN to start the reviews. Notable articles or comments are as follows. The OrthoSphere (Wright Medical) was panned by Brian Adams. David questioned why anyone would ever use an implant that was cleared for marketing by the FDA without a clinical case ever being performed; ditto the Artelon that was 510k'd on silicone. Surgeons should evaluate the evidence supporting the use of any new device prior to using it. Regarding Dick Berger's work on carpal collapse after a trapeziectomy, many wondered if the best xray documenting collapse was as bad as the one in the article, we have reservations about the conclusions, despite Dick's involvement. Regarding the article about meniscal allografts for PRC's, Noah noted that it does not work in the shoulder, so why should it work in the wrist? I am not about to start using it sans clinical evidence of effectiveness and longevity, but it is a notable concept. The cadaveric distal radius distal screw length study by Greenberg was good, but did not conclude with an investigation or suggestion of how long (short) they should be. The review articles for the evidence for lateral epicondylitis and for 1st CMC treatment were well done and useful for thought, esp in light of Szabo's recent lecture on avoiding dogma in hand surgery. We adjourned, looking forward to Bob's hosting June, on the March 09 issue.

April was hosted by Kendrick and Ruth, who offered up a Provencal spring meal of grilled (direct high heat) Le gigot d'agneau and le poulet (lamb and chicken, for those of us who do not speak French). [Kendrick makes the distinction between grilled and BBQ in that grilling is high, direct heat and BBQ is slow, indirect heat, refers you all to http://en.wikipedia.org/wiki/BBQ for further education, and notes that they care about this in Texas, Memphis, and Kansas City.] The dinner was preceeded by wine (Whites:  Kuentz Bas Blanc d'Alsace 2006, Chateau La Roque Languedoc Blanc 2006, Rosé:  Domaine Clavel "Les Mejanelles" Rosé 2007, Reds: Gigondas Domaine Cayron 1998, Bonny Doon Old Telegram 2004, Châteauneuf du Pape Vieux Télégraphe "La Crau" 1995) and hors d'oeuvres of crudités, tapenade, saumon tartare, socca au crevettes. An animated discussion of cases accompanied the food. Members present were Relton, Mat, Rebecca, Noah, Bob, Monty, Bill, David, John, Doug, and Kendrick. Noah showed a one-month-old radial malunion, Relton thanked Becky for the best advice on his radial osteotomy, and David asked advice on a double MCP radial collateral ligament injury. After dinner on the veranda we moved to the dining room and boistrously attacked the Journal. The JN was busy keeping order, as there were 11 of 13 members in attendance. David got a round of applause for upgrading to DSL. A group photo was shot, and Charlotte and Shelley joined in by Photoshop.

March was hosted by Charlotte despite the demands of motherhood. We were treated to cheeses and wine followed by Persian delicacies in honor of her husband's culture. We slowly moved to the Journal despite interesting cases and dispatched the articles as best we could. Our youngest guest, John, was on best behavior and treated us to some biomechanical insights. He tried to be seen but not heard, on this his first visit. Nonetheless, as the evening progressed, he finally offered an opinion on one article, suggesting that it was a waste of paper. Unfortunately, this was the article authored by David, who promptly fished out a few real radii and passed them around. This occasioned a bit of hand washing and the admonishment to keep them away from the food. We adjourned on time, to meet next at Kendrick's, for the annual BBQ in Berkeley.

February was hosted by Doug at 3300 Webster, in the doctor's lounge, which provided great space and work-like ambiance, so we all had a good time. Present were Bob, Relton, Bill, Charlotte, Lisa, Matt, David, and Doug. Chef Doug cooked a la Nelson (translation: deli take-out), but was prescient enough to serve chocolate cake for dessert. The espresso machine was working overtime to keep this rowdy crowd pleased. Lacking Noah to be the JN, David tried but barely conquered, so fierce were the discussions. Stage IV Kienbock's in a 20 year old was agreed to be a tough one, with many votes for PRC with GraftJacket. Always open up the wrist capsule for an infected wrist, even when the infection is outside-in (infected pin), was the consensus. Congrats were freely offered to Monty & Sora on the birth of Azure Nara. Note we are moving from now on to the THIRD Tuesday. Lisa: we hope you will be able to make it often, as you add a lot to our discussion. Next up: Charlotte. New guest, tentative new member: John Agee.

January was kindly hosted, with somewhat short notice, by Rebecca. We had a very special treat because her mother prepared some terrific Chinese "comfort food": dumpling soup, fried rice with shrimp and egg, steamed baby kale, and fried chicken. Present were Bob, Relton, Kendrick, Monty, Charolotte, Doug, Shelley, Bill, Noah, and David; and of course, a cameo appearance by Juno! All admired her and appreciated her quiet demeanor (quite different from Mom!). The case discussions were hogged by David, who seems to have a surplus amount of distal radius cases.

Important administrative affairs regarding new members was discussed, voted on, and then a motion was made to reconsider. This is ongoing. The change of week of the month was made from second to third, in accordance to previous discussions.

December 08 was hosted by Bob, even though Janet was in the hospital with a comminuted inter-troch from a disagreement with her horse and gravity. Present were Kendrick, Relton, Doug, Lisa, Charolotte, Noah, and David. Dinner was a scruptious set of veggie pizzas (Bob's attentions being directed elsewhere), plus a chocolate cake and coffee that made my head swim will all the caffeine. We covered several articles without much depth and called it a night.

Other Meetings of Note

History of Journal Club .