Friday, March 12, 2010

neon burning up above

I'm just high on the world....  

I quite enjoy teaching medical students, and recently went on a course espousing teaching on the run as a way of teaching.  Thus, when I recently got a paediatric elbow injury misdiagnosed as a fracture I used it as a "teachable moment" to talk about the ossification centres about the elbow.

The first ossification centre to appear in the humerus is the diaphyseal (shaft) one, after which the proximal epipheseal (head) ossification centre appears.  At birth both of these (and no others) should be present in the humerus.  There should be radial and ulnar shaft centres and epiphyseal centres at the wrist.

The elbow, however, is a different story.  An X-ray of a newborn elbow should be basically black.  At about six months of age the capitellar centre appears, and then every two years or so a new centre appears (roughly).  The age isn't particularly consistent, and varies between boys and girls, but the order is quite consistent.

When I was a brighteyed and bushytailed medical student, I learnt the mnemonic CRITOE for the order of the centres:

  • Capitellum
  • Radial head
  • Internal (medial) epicondyle
  • Trochlea
  • Olecranon
  • External (lateral) epicondyle

and this is the version I taught.  It has the flaw of using internal and external rather than medial and lateral, but the biggest flaw is that it isn't exactly memorable;  CRITOE after all does not spell a word.  A carebear paediatrician offered up his more memorable version of this:

Come Rub MTummy Of Love

which works quite well and is the version I think I will teach in the future.

The elbow injury was duly referred to the orthopods and if you have ever seen The Todd in Scrubs, you will know orthopaedic humour.  Part of it is the implantation of hardware;  many jokes can be made with the words "screw", "hammer" and "nail":  "I helped the boss screw a fifteen year old boy with a displaced scaphoid";  "Did you nail that girl already?"

The orthopaedic registrar of the day (and his offsider, since orthopods hunt in packs) offered their version:

Come Rub MTree Of Life

Come Rub MTrunk Of Love

Come Rub MThruster Of Love

When I complained about the androcentric nature of these, they offered the (not much nicer)

Come Rub MTunnel Of Love

which of course brings us the the classic Dire Straits: