Yet another clavicle fracture review

Systematic reviews and meta-analyses on clavicle fractures are never ending sources of publications. We did our share by investigating the potential of sources of heterogeneity among RCTs investigating operative and nonoperative treatment in midshaft claviclar fractures. Our study titled Factors explaining heterogeneity in studies comparing surgical and nonsurgical treatment of midshaft clavicle fractures: a meta-regression […]

Role of sisu, a special form of courage, grit, and determination in orthopaedics

Sochacki et al. write as follows in recent study criticizing sham-controlled studies in orthopaedics: Additionally, two studies in this systematic review were performed in Finland. Unfortunately, any study investigating an intervention (e.g. surgery) on individuals born and raised in Finland cannot be extrapolated to the rest of the world. Finns embrace sisu, a special form […]

When you thought you had seen it all… Part 2

Sham-surgery or surgical placebo is increasingly used in orthopaedic randomized controlled trials. Most notable studies include comparison between sham-surgery and arthroscopic partial meniscectomy in knee and arthoscopic subacromial decompression in shoulder. These studies have truly challenged the traditional treatment guidelines in degenerative knee and shoulder conditions. I have previously posted about population level changes in […]

Cup coverage and dislocation risk in THA

This is one of our recent work from Coxa Hospital for Joint Replacement. This relates to post-marketing surveillance which is always very important topic. In short, main primary THR system changed and anecdotal evidence started to accumulate that maybe dislocations had become more common with the new cup system. We decided to take a deeper […]

Views of orthopaedics – part 2

I continue discussing an excellent editorial published in the BJJ. Alex Trompeter writes: We are now seeing the pendulum swing in terms of treatments we select, as our understanding of the science of fracture fixation improves. Moreimportant, however, is the recognition that the patient’s own experience is the most vital outcome when measuring the success […]

Views on orthopaedics motivated by recent editorial – Part 1

A recent editorial in the Bone & Joint Journal was about weight-bearing in orthopaedic traumatology. Written by Alex Trompeter, the title was intriguing: A call to arms: it’s time to bear weight! This editorial was best I have read in a while. Besides weight-bearing, Trompeter addressed many other general topics. In following posts I will […]

Exploratory or confirming study?

Methodology is hard. And making valid inferences is very hard. With regard to these topics, orthopaedic research is not very different to other field in medicine. It means that misconceptions, misunderstandings and flawed approaches are prevalent also in our field. American Journal of Sports Medicine published recently two papers which both made a quite common, […]

Treatment outcomes and shared decision making

Key points Clinical equipoise will become more common in orthopaedics When treatment outcomes are subjective and have large heterogeneity, shared decision making should be used Clinical equipoise means a situation when there is no objective superiority between two choices. The lack of superiority may be due to complete lack of data or evidence about certain […]

Propensity scores, orthopaedics and shared decision making

This is something I posted on Twitter last October. Extended discussion can be found below the tweets Propensity score matching is often used when two cohorts of patient are compared. Aim is to have somewhat comparable groups so effect of treatment or intervention could be estimated reliably. In short, two groups of patient tread by […]