It is well recognised that there is a requirement for military surgeons to treat the victims of penetrating trauma while on operations. Casualty templates from recent and past conflicts demonstrate that a high proportion of survivable injuries affect the limbs; expertise in the management of penetrating trauma to the limbs is clearly important. While it is widely agreed that a combined specialities approach to limb injuries is necessary, debate has been ongoing for some time in the UK military as to the most appropriate means to gain the necessary experience for treating the wounds encountered on operations.

This study examines the operational requirement, looking at data and individual cases from Iraq, and considers the relevance of a training placement at The Johannesburg General Hospital, a level 1 trauma centre in South Africa.

Surgeon Lt Cdr Mercer RN is currently a Specialist Registrar in Vascular Surgery at MDHU Portsmouth and Surgeon Lt Cdr Ayers is a Specialist Registrar in Plastic Surgery at Frenchay Hospital in Bristol.

Introduction: It is said that God gave us paired bilateral anatomical structures so that the trauma surgeon can compare the injured side with its uninjured counterpart. The axial rotational alignment of fingers, when disrupted by injury, may lead to scissoring. During examination, comparison is made between the rotational alignment of injured and uninjured fingers. This assumes that the rotational alignment of the fingers is symmetrical. A study was performed to ascertain normal rotational alignment, and establish whether this assumption is valid.

Materials and Methods: Standardised digital images were taken with fingers in extension. These were analysed using the angle-measuring tool on Adobe Photoshop software. The rotational angle used was that between a line joining the radial and ulnar borders of the nail plate, and the horizontal.

Results: Mean angles of rotation were 13° for the index finger, 10° for the middle, 5° for the ring and 12° for the little. Differences in the angle for ring and little fingers between the sides were not significant; these fingers are symmetrical. Index and middle fingers demonstrated statistically significant asymmetry of 2.6° (SD +/− 4.2°).

Discussion: Previous work has sought to quantify rotational alignment in cadavers or using wire markers and fluoroscopy. A new method, using digital photography and image analysis is described. We determined mean angles, showing symmetry of the ring and little but asymmetry of index and middle. Previous work has suggested that up to 10° of rotation can be tolerated. With only 2.6° of difference, clinical comparison of sides remains appropriate.