Number 129 November-December, 1971
Letters to the Editor
duction. We earnestly regret the inaccuracies of our statements, and we appreciate Dr. Griffin bringing this important concept to the attention of Clinical Orthopaedics readers. DAVIDP. GREEN, M.D. Professor of Orthopaedics, Chief;Hand Surgery Service, The University of Texas, Health Science Center at San Antonio,
321
7703 Floyd Curl Drive, San Antonio, Texas 78284 REFERENCES 1. Davis. D. R. and Green, D. P.: Forearm
fractures in children. Pitfalls and complications, Clin. Orthop. 120:172, 1976. 2. Evans, E. M.: Rotational deformity in the treatment of fractures of both bones of the forearm, J. Bone Joint Surg. 27:373, 1945. 3. : Fractures of the radius and ulna, J Bone Joint Surg. 33B:548, 1951.
The Terry-Thomas Sign Dear Sir: Dislocations and subluxations of the carpal scaphoid are relatively rare, difficult to diagnose, and frequently overlooked. Watson-Jones6 reported five cases from the R.A.F. Orthopaedic Service in World War 11. Bohler' mentioned 2 cases. Thompson, Campbell, and Arnold5 in a comprehensive article reported 9 cases, 7 of which were difficult to diagnose. Linscheid et a1.2 recently reviewed the diagnosis, classification, and pathomechanics. The carpus has always been a difficult area for the student of anatomy and radiology. All first-year anaiomy students know the mnemonic aid for the names and locations of the bones: Never Lower Tillie's Pants Grandma May Come Home. The application of anthropomorphic similies supplies us with diagnostic clues and triggers that simplify the complicated and clarify the opaque. Osler3 states that it is difficult to learn the physiognomy of disease, and it is to physiognomy that we turn for help in recognizing a difficult wrist subluxation. Terry-Thomas, born Thomas Terry HoarStevens on Bastille Day, 1911, in London, is well known to the aficionados of British comedy. He is a comedian who despite an upper central dental diastema has a winning
and unforgettable smile. He also has a notto-be-forgotten grimace (Fig- 1 An art student was Seen 4 months after a motorcycle accident in which he fell on his outstretched hand. X-rays taken at that time
-
FIG. I . Dental diastema: facies (Courtesy of Mr. Terry-Thomas) .
322
Clinical Orthopadlcr and Rotated Rormrch
Letters to the Editor
FIG.3. Dental dif acies
astema: Kop;dta.
of
Mr.
(Courtesy Terry-
Thomas)
FIGS. 2A and B. ( A , left) An anteroposterior radiograph showing rotational subluxation of the navicular, with a gap between the navicular and lunate. (B, right) The gap has been abolished by rotating the navicular and fixing it with 2 wires. were reported as negative. He complained of difficulty in utilizing an impasto technique. The gap between the navicular and lunate, diagnostic of a rotational subluxation of the navicular, immediately made one think of Terry-Thomas (Fig. 2A). Thus the TerryThomas sign was born. Subluxation involves rotation backwards of the proximal pole and rotation forward of the distal pole. The navicular may appear foreshortened. A gap is diagnostic, but may be detected only on an anteroposterior view taken in supination. Terry-Thomas has written an autobiography4 which provides us with a clue as to the treatment. Its title, Filling the Gap, is a good operative indication. The gap is filled by rotating the navicular and fixing it with pins and/or a cast (Fig. 2B). Proper recognition of this not-so-rare condition can turn the facies of spaywdia to
SUMMARY The application of anthropomorphic similies can aid in the recognition of conditions that are difficult to diagnose and easily overlooked. Dental diastema (the classic Terry-
Thomas dental pattern) is a useful anthropomorphic sign in detecting rotatory luxation of the navicular. VICTORH. FRANKEL, M.D. Professor and Chairman, Department of Orthopaedics, School of Medicine, University of Washington, Seattle, Washington 981 95 ACKNOWLEDGMENT I wish to thank Mr. Terry-Thomas for permission to use his name as a mnemonic aid for rotational subluxation of the navicular. REFERENCES 1. Bohler, L.: The treatment of fractures, New York and London, Grune and Stratton, 1956,
p. 854. 2. Linscheid, R. L., Dobyns, 3. H., Beabout. J. W. and Bryan, R. S.: Traumatic instability of the wrist: diagnosis, classification, and pathomechanics, J. Bone Joint Surg. 54A: 1612, 1972. 3. Osler, Sir W.: Aphorisms from His Bedside Teachings and Writings, collected by Robert Bennett Bean, edited by William Bennett Bean. New York, Henry Schurnan, Inc., 1950. 4. Thomas, T.: Filling the Gap, Toronto, Clarke. Irwin, Inc. 1959. 5. Thompson, T. C., Campbell, R. D., Jun. and Arnold,. W. D.: Primary and secondary dislocation of the scaphoid bone, J. Bone Joint Surg. 46B:73, 1964. 6. Watson-Jones, Sir R.: Fractures and Joint Injuries, 4th ed., Baltimore, Williams and Wilkins Co., 1955, p. 620.
Letters to the Editor
duction. We earnestly regret the inaccuracies of our statements, and we appreciate Dr. Griffin bringing this important concept to the attention of Clinical Orthopaedics readers. DAVIDP. GREEN, M.D. Professor of Orthopaedics, Chief;Hand Surgery Service, The University of Texas, Health Science Center at San Antonio,
321
7703 Floyd Curl Drive, San Antonio, Texas 78284 REFERENCES 1. Davis. D. R. and Green, D. P.: Forearm
fractures in children. Pitfalls and complications, Clin. Orthop. 120:172, 1976. 2. Evans, E. M.: Rotational deformity in the treatment of fractures of both bones of the forearm, J. Bone Joint Surg. 27:373, 1945. 3. : Fractures of the radius and ulna, J Bone Joint Surg. 33B:548, 1951.
The Terry-Thomas Sign Dear Sir: Dislocations and subluxations of the carpal scaphoid are relatively rare, difficult to diagnose, and frequently overlooked. Watson-Jones6 reported five cases from the R.A.F. Orthopaedic Service in World War 11. Bohler' mentioned 2 cases. Thompson, Campbell, and Arnold5 in a comprehensive article reported 9 cases, 7 of which were difficult to diagnose. Linscheid et a1.2 recently reviewed the diagnosis, classification, and pathomechanics. The carpus has always been a difficult area for the student of anatomy and radiology. All first-year anaiomy students know the mnemonic aid for the names and locations of the bones: Never Lower Tillie's Pants Grandma May Come Home. The application of anthropomorphic similies supplies us with diagnostic clues and triggers that simplify the complicated and clarify the opaque. Osler3 states that it is difficult to learn the physiognomy of disease, and it is to physiognomy that we turn for help in recognizing a difficult wrist subluxation. Terry-Thomas, born Thomas Terry HoarStevens on Bastille Day, 1911, in London, is well known to the aficionados of British comedy. He is a comedian who despite an upper central dental diastema has a winning
and unforgettable smile. He also has a notto-be-forgotten grimace (Fig- 1 An art student was Seen 4 months after a motorcycle accident in which he fell on his outstretched hand. X-rays taken at that time
-
FIG. I . Dental diastema: facies (Courtesy of Mr. Terry-Thomas) .
322
Clinical Orthopadlcr and Rotated Rormrch
Letters to the Editor
FIG.3. Dental dif acies
astema: Kop;dta.
of
Mr.
(Courtesy Terry-
Thomas)
FIGS. 2A and B. ( A , left) An anteroposterior radiograph showing rotational subluxation of the navicular, with a gap between the navicular and lunate. (B, right) The gap has been abolished by rotating the navicular and fixing it with 2 wires. were reported as negative. He complained of difficulty in utilizing an impasto technique. The gap between the navicular and lunate, diagnostic of a rotational subluxation of the navicular, immediately made one think of Terry-Thomas (Fig. 2A). Thus the TerryThomas sign was born. Subluxation involves rotation backwards of the proximal pole and rotation forward of the distal pole. The navicular may appear foreshortened. A gap is diagnostic, but may be detected only on an anteroposterior view taken in supination. Terry-Thomas has written an autobiography4 which provides us with a clue as to the treatment. Its title, Filling the Gap, is a good operative indication. The gap is filled by rotating the navicular and fixing it with pins and/or a cast (Fig. 2B). Proper recognition of this not-so-rare condition can turn the facies of spaywdia to
SUMMARY The application of anthropomorphic similies can aid in the recognition of conditions that are difficult to diagnose and easily overlooked. Dental diastema (the classic Terry-
Thomas dental pattern) is a useful anthropomorphic sign in detecting rotatory luxation of the navicular. VICTORH. FRANKEL, M.D. Professor and Chairman, Department of Orthopaedics, School of Medicine, University of Washington, Seattle, Washington 981 95 ACKNOWLEDGMENT I wish to thank Mr. Terry-Thomas for permission to use his name as a mnemonic aid for rotational subluxation of the navicular. REFERENCES 1. Bohler, L.: The treatment of fractures, New York and London, Grune and Stratton, 1956,
p. 854. 2. Linscheid, R. L., Dobyns, 3. H., Beabout. J. W. and Bryan, R. S.: Traumatic instability of the wrist: diagnosis, classification, and pathomechanics, J. Bone Joint Surg. 54A: 1612, 1972. 3. Osler, Sir W.: Aphorisms from His Bedside Teachings and Writings, collected by Robert Bennett Bean, edited by William Bennett Bean. New York, Henry Schurnan, Inc., 1950. 4. Thomas, T.: Filling the Gap, Toronto, Clarke. Irwin, Inc. 1959. 5. Thompson, T. C., Campbell, R. D., Jun. and Arnold,. W. D.: Primary and secondary dislocation of the scaphoid bone, J. Bone Joint Surg. 46B:73, 1964. 6. Watson-Jones, Sir R.: Fractures and Joint Injuries, 4th ed., Baltimore, Williams and Wilkins Co., 1955, p. 620.
