Summary Statement. With increasing emphasis on evidence-based medicine in healthcare, there is global increase in proportion of Level-1 and -2 articles in PUBMED. This study shows the trend of orthopaedic publications from different countries in comparison to other specialties. Introduction. New medical knowledge is expected to improve health through change in existing practices. Articles need to convince readers of the validity of conclusions in order to bring about a change in practice. The last few decades have witnessed an increasing interest in critical appraisal of research aimed at assessing the ‘quality’ of evidence, a trend towards ‘Evidence Based Medicine’. Whether orthopaedic publications are also becoming more evidence-based has hitherto not been reported. This study aimed to compare the trend of publications originating from orthopaedic services versus other specialties, across different countries, with respect to major categories of levels of evidence. Methods. PUBMED was used to collect data on yearly publication of articles, categorised by country, specialty (from author address) and article category (Guideline, Review, Case Report, Comparative Study, Clinical Trial and Meta-Analysis). Results. PUBMED shows 20,572,125 articles published between 1900 and 2010. Of these, 64% were published within the quarter century 1986–2010. Publication type was specified in 25% of articles, of which 8% were review articles, 7% each were case reports and comparative studies while 3% were clinical trials. The top ten countries from which articles originated were US, UK, Japan, Germany, France, Canada, Italy, Australia, Netherlands and Sweden. Comparing the decade of 1990s with 2000s, the number of meta-analyses showed greatest increase from Australia, Japan, Germany, UK and Italy (9.5x-6.1x). When comparing types of articles between the beginning and end of the quarter century, the proportion of clinical trials increased by 2x, guidelines by 5x and meta-analyses/systematic reviews by 28x. There were 121,859 articles from orthopaedic departments/institutes (0.6% of all articles). There was a consistent increase in the proportion of orthopaedic publications from 0.5% to 1.1% over the quarter century; this 231% increase was lower than vascular, cardiothoracic and paediatric surgery but greater than urology, neurosurgery, otolaryngology and obstetrics/gynecology. Among the different types of publications, in orthopaedics the greatest increase between the decades of 1990s and 2000s was in meta-analyses (8.5x) followed by guidelines (5.4x). This increase in number of meta-analyses was higher than other surgical specialties except cardiothoracic and
Objectives. The period of post-operative treatment before surgical wounds
are completely closed remains a key window, during which one can
apply new technologies that can minimise complications. One such
technology is the use of negative pressure wound therapy to manage
and accelerate healing of the closed incisional wound (incisional
NPWT). . Methods. We undertook a literature review of this emerging indication
to identify evidence within orthopaedic surgery and other surgical
disciplines. Literature that supports our current understanding
of the mechanisms of action was also reviewed in detail. . Results. A total of 33 publications were identified, including nine clinical
study reports from orthopaedic surgery; four from cardiothoracic
surgery and 12 from studies in abdominal, plastic and vascular disciplines.
Most papers (26 of 33) had been published within the past three
years. Thus far two randomised controlled trials – one in orthopaedic
and one in cardiothoracic surgery – show evidence of reduced incidence
of wound healing complications after between three and five days
of post-operative NPWT of two- and four-fold, respectively. Investigations
show that reduction in haematoma and seroma, accelerated wound healing
and increased clearance of oedema are significant mechanisms of
action. . Conclusions. There is a rapidly emerging literature on the effect of NPWT
on the closed incision. Initiated and confirmed first with a randomised
controlled trial in orthopaedic trauma surgery, studies in abdominal,
plastic and
Long-term regeneration of cartilage defects treated with tissue engineering constructs often fails because of insufficient integration with the host tissue. We hypothesize that construct integration will be improved when implants actively interact with and integrate into the subchondral bone. Growth and Differentiation Factor 5 (GDF-5) is known to support maturation of chondrocytes and to enhance chondrogenic differentiation and hypertrophy of mesenchymal stromal cells (MSC). Therefore, we investigated whether GDF-5 is capable to stimulate endochondral ossification of MSC in vitro and in vivo and would, thus, be a promising candidate for augmenting fibrin glue in order to support integration of tissue engineering constructs into the subchondral bone plate. To evaluate the adhesive strength of fibrin glue versus BioGlue. ®. , a commercially available glue used in
