Commentary on “Tips and pitfalls of reduction and fixation in displaced supracondylar fractures in children”

I read Kim et al. article^[1] with great interest on the tips and pitfalls in the surgical treatment of pediatric supracondylar fractures. As in any surgical procedure, surgeon experience is crucial to avoid complications and achieve good results. However, in unstable pediatric supracondylar fractures, the proficiency gap is notable, particularly when comparing the frequency of open reduction, which can be as high as 30% for novice surgeons, in contrast with 1% for experts. The simple enumeration of the surgical technique will never do justice to the complexity of this procedure, which is why “tips and tricks” from an expert are extremely valuable for young surgeons.

The surgical skills that allow an expert to consistently achieve good results can be challenging for a novice, particularly if the teachers do not make conscious efforts to transmit them to their students. We are all familiar with the expert surgeons (or clinicians) who, through the mastery of their craft, seem to make the diagnosis and management as if by magic, and breeze through complicated procedures as if they presented no challenge at all. Even though all students aspire to reach that level of expertise, they can also be discouraged if the gap between their current and desired level of expertise is too great.

Many authors have emphasized the importance of enumerating explicitly the steps taken when performing a clinical skill to facilitate the student’s learning process and allow them to integrate said skill into their body of knowledge and practice, allowing them to reproduce it successfully. This effort to “make the implicit explicit” is extremely important in all levels of clinical teaching, from the earliest clinical rotations of medical school, up to residency and fellowship training, and should be a conscious and consistent action by all clinical educators.

The high level of detail in discussing supracondylar fracture reduction techniques that Kim et al. present in their paper is only achieved through careful introspection and analysis of one’s daily practice. Every surgeon who works with students would be well-served by making a similar effort; this will benefit not only our students but also ourselves, allowing us to bring structure to our thought process, helping our never-ending quest to be the best surgeon we can all be.