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7.5/365 An explanation. Having taken over as BOA President it seemed appropriate to follow other leading presidents and tweet. So, a tweet a day for a year with a count of how many of the 365 completed. As a point of order this only merits a 0.5. Some days the barrel is scraped.

8/365 How a myth begins? “A splinter left in your finger can get infected, go to your heart and poison you” my dad told me while carefully extricating a tiny fragment. Years later at medical school I learned of splinter haemorrhages. Dad had had rheumatic fever as a child!

*NEW* Important message from BOA for anyone waiting on #jointreplacement and other elective #orthopaedic #surgery. Please share this to help us reach those who are affected. boa.ac.uk/Patient-COVID-…

9/365 When a plan is made it is useful to consider whether there is a way for which there is an instinctive preference, or desire path. Ignoring that “desire path” makes compliance less likely whether the new footfall be real or metaphorical.

10/365 We classify and label to order the world around us. Labels should illuminate not obscure or prejudice. “Does he take sugar” a phrase that opened my mind. All are prone to lax labelling hence the last JTO cover; it is my parents in the picture. boa.ac.uk/resources/know…

11/365 Keeping an open mind is difficult. It is easy to presume that our own way of looking at something is the correct or normal way. A different perspective may literally turn our world upside down. A sign from an airline office in Argentina

12/365 How consistent is your team? A 6 bedded ITU each with a nurse needs about 36 whole time equivalents. Conveniently equating to about 49 individuals. With random rotas the old UK Lottery odds of the same group working together twice; a 1 in 14 million chance. Not intuitive?

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.

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.

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.

16/365 Reduction 2. Intuitive to a child is that if you have a multi-fragmentary pig it is best to view the big picture and build a frame of reference (the straight edged pieces). The necessary alignment of snout and trotter is then achieved even if pieces are missing or unplaced

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.

What size hammer? A Newton’s cradle or billiards shows us tidy and almost complete transfer of energy if colliding elastic objects are equal. Why then in theatre do we tend to use one size of mallet to for all tasks in the vain hope that "skill" can defy the laws of physics?

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

Amazing #OpenAccess resource from the Fragility Fracture Network. BOA British Trauma Society

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.

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.

New BOA statement* BOA welcomes extra £1bn for England elective care backlog, but concerned this will not go far enough to deal with enormity of waiting list. #Orthopaedics has biggest wait list and situation is intolerable for many patients.

Hard hitting meeting with the Presidents of the RCS of England and Edinburgh - trying to find ways to help our patients, surgeons and trainees.. no magic wand but undeniably a willingness to continue to work together..BOA Rob Gregory BOTA Professor Rowan Parks Neil Mortensen

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