Chance Encounters

I'm not a superstitious person, but sometimes the world makes me wonder. The other day, I experienced a confluence of events that made me just a little superstitious.

Early in the morning, I was driving in to one of my local hospitals where I had a couple of surgical cases scheduled. As I was driving in, one of my residents called to let me know there was a patient at the hospital with a 5th toe fracture dislocation that would require surgical repair. Now, I don't know about you, but in my practice, the vast majority of toe fractures require nothing more than buddy splinting. I haven't had to surgically repair a toe fracture for several years, and I've never had to do surgery on a 5th toe fracture. To make this situation more unusual, the fracture was at the middle phalanx of the toe. How rare is that?

Actually...how rare IS that?

A study in the Journal of Foot and Ankle Surgery looked at the epidemiology of digital fractures.¹ The study authors examined a consecutive cohort of phalangeal fractures counted from a registry over 30 months in a level 2 trauma hospital. The authors identified 339 patients with 370 phalangeal fractures. Of these, a grand total of five fractures were of the middle phalanx of the 5th toe. Of these 370 phalangeal fractures, exactly zero needed surgery. This calculates out to a 1.35% incidence of middle phalangeal fractures.

Pretty rare, I'd say.

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Add to this the coincidences that the patient injured herself two hours prior to my arrival at the hospital, AND she happened to be NPO since 8 PM the night before! The coincidences kept coming.

We "ORIF'ed" the patient's toe in a matter of 10 minutes without complications. Lucky for our patient that these coincidences coalesced just at the right time! Of course, one could argue that she wasn't so lucky to have injured herself, but I prefer to remain positive.

Another chance encounter happened to me, coincidentally on the same day as my patient's experience. Fast forward about 10 hours. I'm driving home on the freeway when all of a sudden I see some chains in my lane. I swerve to avoid them, but alas my right front tire drives right over the chains. I thought this would be an uneventful situation until about five minutes later my tire indicator light lit up. I limped my car off the freeway, changed the tire, and drove to the nearest tire shop. Two hours and $213 later I finally made it home.

The chance part of my tire experience is again seen through a conglomeration of isolated situations. First, if you're not familiar with Southern California freeways I can tell you that they are large and fast. The freeway I was driving on was six lanes wide. Who could guess that those damn chains would happen to be in my lane at exactly the time I was driving home? Additionally, my damaged tire just happened to have been repaired about a month previously when a slow leak occurred due to a nail.

Perhaps the funniest part of all this was that the guy who replaced my tire happens to have been one of my coworkers' friends who recently left the College! This was realized when he saw the parking pass for Western University hanging from my rearview mirror.

Coincidences abound. The rational part of me explains these off in very reasonable ways. For example, it's highly likely based on the amount of time I spend at the hospital that a patient would eventually come at just the right time, just by random chance. Similarly, given the poor infrastructure maintenance in much of our country, and Southern California in general, it may not be surprising that I would drive over debris in the road with one of my front tires (much more likely to hit something than the back tires).

Of course, the very small irrational superstitious side of me tries to explain this day off as some part of a greater cosmic structure. Just for fun, I took a look at the astrological forecast for this particular day and read the following:

I probably should have ridden my bike to work, and I'm certain I put some sweat into my adventure while changing the car's tire, though I'm still not sure what benefit this adventure yielded. It certainly was unexpected. It can't hurt to hang a rabbit's foot from my rearview mirror…right?

Best wishes,

Jarrod Shapiro, DPM
PRESENT Practice Perfect Editor
[email protected]

References

1. Vliet-Koppert V, et al. Demographics and functional outcome of toe fractures. Journal of Foot and Ankle Surgery. 2011;50:307-310.
2. Black L. Astrological Forecasts for 2/26/2015. The Seattle Times. Last accessed 2/28/15.

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