At the 61st annual meeting of the American Society for Surgery of the Hand in September of 2006, a distinguished panel of experts moderated by William B. Kleinman, MD, explained why they had abandoned a previously used or recommended surgical procedure or treatment modality for their patients. The abandoned procedures included the closed treatment of nondisplaced scaphoid fractures, endoscopic carpal tunnel release, intercarpal fusion for intercarpal instability, ulna lengthening in osteochondromatosis, external fixation of distal radius fractures, and the use of cement in the hand and wrist.
The presentations gave the listener a current and candid opinion from the various panel members about a procedure or technique that had not, in their opinion, withstood careful scrutiny based on its inability to effectively "hold up" over time or had consistently poor results.
Some of the "abandonments" were startling and, no doubt, have and will be associated with a high level of controversy among those of us that practice hand surgery. You, like the panel of experts, may have "given up" some of these procedures at this point in your career and perhaps are even now reevaluating other procedures as to their long-term benefit to your patients.
It is not my intent to address the usefulness of any of the above-mentioned procedures or techniques. That was well done by the panelists. However, a parting comment by one of the very experienced surgeons on the panel bears repeating here (my paraphrase): "Do what you do best." One implication or interpretation of these words is that if a procedure has and is working well in your practice, based on careful scrutiny and suitable follow-up time, then continue to use it.
A final caveat: what works for you may not work for me and vice versa.
The philosophy of the editors-in-chief and the editorial board of this journal is to present, in a timely fashion, current techniques in hand and upper extremity surgery. Will all these techniques stand up to careful and long-term scrutiny? Time and experience will give the answer.
James R. Doyle, MD
Emeritus Professor of Surgery (Orthopedics)
John A. Burns School of Medicine
University of Hawaii