Mount Rainier is a popular climbing destination. Approximately 10,000 registered climbers attempt to reach its 14,000 foot summit each year. From the graph below we can see that the base rate for fatalities among these climbers averages about 3 per ten thousand (0.3 per thousand). However, the per year rate varies substantially. We are unable to predict the death rate for the coming year because we cannot anticipate what factors will contribute to the death rate in 2026. Daniel Kaheman refers to this as "objective ignorance".
A striking example of our inability to predict the occurrence of climbing deaths was in 1981when an avalanche killed 11 Rainier climbers. This event stands as the deadliest mountaineering accident in U.S. history. On that day, a group of 29 climbers, including guides and clients from Rainier Mountaineering Inc., were ascending the Ingraham Glacier route. At approximately 5:45 a.m., a massive serac—an unstable block of glacial ice—broke loose from the upper Ingraham Glacier, triggering an avalanche of ice and snow. The avalanche swept through the climbers' resting area near Disappointment Cleaver, burying 11 individuals under tons of ice and snow. Despite extensive search efforts, the victims' bodies were never recovered and remain entombed within the glacier.
As an aside, my wife and I (and many others) safely summited Rainier by the Ingraham Glacier route both before and after that accident.
Climbers refer to avalanches as objective hazards - dangers that exist independently of a person's actions, skill, or decisions - they are external, uncontrollable risks inherent to the environment. In this case the National Park Service Board determined "that the accident was a random event that could not have been predicted."
In orthopaedic surgery, objective ignorance keeps us from accurately predicting outcomes for our patients. As pointed out in a prior post, two year ASES scores for patients with cuff intact arthritis having reverse total shoulder arthroplasty have a base rate averaging 83 [SD 12.6]. Yet these numbers do not enable surgeons to accurately predict the result in an individual case because we are ignorant of the "random events" that could have profound effects on the outcome realized by the patient. An unexpected optimization of their social or rehabilitation support may lead an exceptionally good recovery. Conversely, the outcome is likely to be subpar after an acromial/spine stress fracture or the onset of Parkinson's Disease leading to multiple falls and dislocations. In addition, the new implants a surgeon has started to use may be found to have consistently better outcomes, or they may have a design flaw that only becomes evident months after the procedure.
The point here is that while we may know the average base rates for the outcomes of surgical procedures performed in the past, we need to be cautious about using this information to make predictions about future results for an individual patient because we are ignorant of the objective factors that may affect that person's outcome.
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Here are some videos that are of shoulder interest
Shoulder arthritis - what you need to know (see this link).
How to x-ray the shoulder (see this link).
The ream and run procedure (see this link).
The total shoulder arthroplasty (see this link).
The cuff tear arthropathy arthroplasty (see this link).
The reverse total shoulder arthroplasty (see this link).
The smooth and move procedure for irreparable rotator cuff tears (see this link)
Shoulder rehabilitation exercises (see this link).
Follow on twitter/X: https://x.com/RickMatsen
Follow on facebook: https://www.facebook.com/shoulder.arthritis
Follow on LinkedIn: https://www.linkedin.com/in/rick-matsen-88b1a8133/
Here are some videos that are of shoulder interest
Shoulder arthritis - what you need to know (see this link).
How to x-ray the shoulder (see this link).
The ream and run procedure (see this link).
The total shoulder arthroplasty (see this link).
The cuff tear arthropathy arthroplasty (see this link).
The reverse total shoulder arthroplasty (see this link).
The smooth and move procedure for irreparable rotator cuff tears (see this link)
Shoulder rehabilitation exercises (see this link).
