Change of attitude

Objective superiority between treatment options is becoming rarer in orthopaedics. This means that in numerous conditions, such as in Achilles tendon ruptures, distal radius fractures in the elderly patients and midshaft clavicle fractures, superiority of treatment options, namely operative and nonoperative, is based on patient values and preferences.

Patient may not value slightly reduced risk of rerupture, lower risk of nonunion or faster return to daily activities so much that he or she would opt for surgery. Outcomes we measure in orthopaedics are relative and value-based because hard outcomes, such as mortality, are not usually relevant outcome measures.

All this means that we must accept this new paradigm in our field and we need a change of an attitude. This means that surgeon cannot always say which is better for our patients. We need to consult our patients and engage on shared-decision making process. This practice should also be implemented and transparently adopted in the interpretation of research findings.

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