Objectives. To explore whether orthopaedic surgeons have adopted the Proximal Fracture of the Humerus: Evaluation by Randomisation (PROFHER) trial results routinely into clinical practice. Methods. A questionnaire was piloted with six orthopaedic surgeons using a ‘think aloud’ process. The final questionnaire contained 29 items and was distributed online to surgeon members of the British Orthopaedic Association and British Elbow and Shoulder Society. Descriptive statistics summarised the sample characteristics and fracture treatment of respondents overall, and grouped them by whether they changed practice based on PROFHER trial findings. Free-text responses were analysed qualitatively for emerging themes using Framework Analysis principles. Results. There were complete responses from 265 orthopaedic and trauma surgeons who treat patients with proximal humeral fractures. Around half (137) had changed practice to various extents because of PROFHER, by operating on fewer PROFHER-eligible fractures. A third (43) of the 128 respondents who had not changed practice were already managing patients non-operatively. Those who changed practice were more likely to be younger, work in a trauma unit rather than a major trauma centre, be specialist shoulder surgeons and treat fewer PROFHER-eligible fractures surgically. This group gave higher scores when assessing validity and applicability of PROFHER. In contrast, a quarter of the non-changers were critical, sometimes emphatically, of PROFHER. The strongest theme that emerged overall was the endorsement of
Evidence -based medicine (EBM) is designed to inform clinical decision-making within all medical specialties, including orthopaedic surgery. We recently published a pilot survey of the Canadian Orthopaedic Association (COA) membership and demonstrated that the adoption of EBM principles is variable among Canadian orthopaedic surgeons. The objective of this study was to conduct a broader international survey of orthopaedic surgeons to identify characteristics of research studies perceived as being most influential in informing clinical decision-making. A 29-question electronic survey was distributed to the readership of an established orthopaedic journal with international readership. The survey aimed to analyse the influence of both extrinsic (journal quality, investigator profiles, etc.) and intrinsic characteristics (study design, sample size, etc.) of research studies in relation to their influence on practice patterns.Objectives
Materials and Methods
Ketamine has been used in combination with a
variety of other agents for intra-articular analgesia, with promising results.
However, although it has been shown to be toxic to various types
of cell, there is no available information on the effects of ketamine
on chondrocytes. We conducted a prospective randomised controlled study to evaluate
the effects of ketamine on cultured chondrocytes isolated from rat
articular cartilage. The cultured cells were treated with 0.125
mM, 0.250 mM, 0.5 mM, 1 mM and 2 mM of ketamine respectively for
6 h, 24 hours and 48 hours, and compared with controls. Changes of
apoptosis were evaluated using fluorescence microscopy with a 490
nm excitation wavelength. Apoptosis and eventual necrosis were seen
at each concentration. The percentage viability of the cells was
inversely proportional to both the duration and dose of treatment
(p = 0.002 and p = 0.009). Doses of 0.5 mM, 1 mM and 2mM were absolutely
toxic. We concluded that in the absence of solid data to support the
efficacy of intra-articular ketamine for the control of pain, and
the toxic effects of ketamine on cultured chondrocytes shown by
this study, intra-articular ketamine, either alone or in combination
with other agents, should not be used to control pain. Cite this article:
The peer review process for the evaluation of
manuscripts for publication needs to be better understood by the
orthopaedic community. Improving the degree of transparency surrounding
the review process and educating orthopaedic surgeons on how to
improve their manuscripts for submission will help improve both
the review procedure and resultant feedback, with an increase in
the quality of the subsequent publications. This article seeks to clarify
the peer review process and suggest simple ways in which the quality
of submissions can be improved to maximise publication success. Cite this article:
To review the current best surgical practice and detail a multi-disciplinary
approach that could further reduce joint replacement infection. Review of relevant literature indexed in PubMed.Objectives
Methods
We aimed first to summarise minimal clinically important differences
(MCIDs) after total hip (THR) or knee replacement (TKR) in health-related
quality of life (HRQoL), measured using the Short-Form 36 (SF-36).
Secondly, we aimed to improve the precision of MCID estimates by
means of meta-analysis. We conducted a systematic review of English and non-English articles
using MEDLINE, the Cochrane Controlled Trials Register (1960–2011),
EMBASE (1991–2011), Web of Science, Academic Search Premier and
Science Direct. Bibliographies of included studies were searched
in order to find additional studies. Search terms included MCID
or minimal clinically important change, THR or TKR and Short-Form
36. We included longitudinal studies that estimated MCID of SF-36
after THR or TKR.Objectives
Methods
To assess the sensitivity and specificity of self-reported osteoporosis
compared with dual energy X-ray absorptiometry (DXA) defined osteoporosis,
and to describe medication use among participants with the condition. Data were obtained from a population-based longitudinal study
and assessed for the prevalence of osteoporosis, falls, fractures
and medication use. DXA scans were also undertaken.Objectives
Methods
Osteoarthritis (OA) is an important cause of
pain, disability and economic loss in humans, and is similarly important in
the horse. Recent knowledge on post-traumatic OA has suggested opportunities
for early intervention, but it is difficult to identify the appropriate
time of these interventions. The horse provides two useful mechanisms
to answer these questions: 1) extensive experience with clinical
OA in horses; and 2) use of a consistently predictable model of
OA that can help study early pathobiological events, define targets
for therapeutic intervention and then test these putative therapies.
This paper summarises the syndromes of clinical OA in horses including
pathogenesis, diagnosis and treatment, and details controlled studies
of various treatment options using an equine model of clinical OA.
