Does flattery work? A comparison of 2 different cover letters for an international survey of orthopedic surgeons.

Background: Surveys are an important tool for gaining information about physicians' beliefs, practice patterns and knowledge. However, the validity of surveys among physicians is often threatened by low response rates. We investigated whether response rates to an international survey could be increased using a more personalized cover letter.

Osteogenic effects of traumatic brain injury on experimental fracture-healing.

Background: Heterotopic bone formation has been observed in patients with traumatic brain injury; however, an association between such an injury and enhanced fracture-healing remains unclear. To test the hypothesis that traumatic brain injury causes a systemic response that enhances fracture-healing, we established a reproducible model of traumatic brain injury in association with a standard closed fracture and measured the osteogenic response with an in vitro cell assay and assessed bone-healing with biomechanical testing.

Methods: A standard closed femoral fracture was produced in forty-three Sprague-Dawley rats.

Common errors in the design of orthopaedic studies.

There are several issues that one has to take into consideration in order to avoid potential pitfalls in the design of orthopaedic studies. This article highlights how to avoid common errors and how to continue the drive towards the unattainable, but laudable, goal of perfection.

Percutaneous management of Morel-Lavallee lesions.

Background: Previous recommendations for treatment of Morel-Lavallee soft-tissue degloving lesions have included open débridement with packing or delayed closure. The purpose of this study was to review the use of percutaneous drainage for the initial management of these lesions.

Methods: Nineteen patients with a Morel-Lavallee lesion were managed with percutaneous drainage and débridement of the lesion within three days after the injury.

Level of evidence in orthopaedic journals.

Background: The American edition of The Journal of Bone and Joint Surgery (JBJS-A) has included a level-of-evidence rating for each of its clinical scientific papers published since January 2003. The purpose of this study was to assess the type and level of evidence found in nine different orthopaedic journals by applying this level-of-evidence rating system.

Methods: We reviewed all clinical articles published from January through June 2003 in nine orthopaedic journals.

Operative management of displaced femoral neck fractures in elderly patients. An international survey.

Background: Hip fractures occur in 280,000 North Americans each year. Although surgeons have reached consensus with regard to the treatment of undisplaced fractures of the hip, the surgical treatment of displaced fractures remains controversial. Identifying surgeons' preferences in techniques, and the rationale for their choices, may aid in focusing educational activities to the orthopaedic community as well as planning future clinical trials.

Expected outcomes after pelvic ring injury.

Pelvic ring injuries are a result of high-energy trauma and are often associated with nonskeletal injuries. Although malunions and nonunions are rare with the use of current techniques of reduction and fixation, outcome studies show that these injuries have long-lasting effects. Associated urologic and neurologic injuries are commonly the determinants of outcome.

Displaced intra-articular calcaneal fractures.

Background: Calcaneal fractures comprise 1 to 2 percent of all fractures. Approximately 75% of calcaneal fractures are intra-articular. The management of intra-articular calcaneal fractures remains controversial.

An observational study of duplicate presentation rates between two national orthopedic meetings.

Background: National meetings such as those of the American Academy of Orthopaedic Surgeons (AAOS) and the Canadian Orthopaedic Association (COA) are invaluable in the dissemination of new research findings. Given the limits of meeting agendas, investigators who present the same paper at multiple meetings prevent other presentations on potentially important original research. To determine the incidence of duplicate presentation of research between recent COA and AAOS meetings and between national meetings (AAOS and subspecialty), we conducted an observational study.

Standard multiplanar fluoroscopy versus a fluoroscopically based navigation system for the percutaneous insertion of iliosacral screws: a cadaver model.

Objectives: To compare the safety and efficiency of standard multiplanar fluoroscopy (StdFluoro) and virtual fluoroscopy (VirtualFluoro) for use in the percutaneous insertion of iliosacral screws.

Design: : Human cadaver study comparing 2 imaging modalities during iliosacral screw insertion; imaging randomized from side to side.

Setting: Bioskills laboratory in a medical school.

Intramedullary nailing following external fixation in femoral and tibial shaft fractures.

Background: Intramedullary nailing is the standard of care for the definitive management of lower extremity long bone fractures. Occasionally, temporary external fixation is used in fractures with severe open wounds or vascular injury before definitive intramedullary nailing. Secondary intramedullary nailing following external fixation is somewhat controversial, especially with respect to the duration of external fixation that is allowable before the risk of infection following later nailing becomes too great.

Internet versus mailed questionnaires: a controlled comparison (2).

Background: Low response rates among surgeons can threaten the validity of surveys. Internet technologies may reduce the time, effort, and financial resources needed to conduct surveys.

Objective: We investigated whether using Web-based technology could increase the response rates to an international survey.

Percutaneous pin placement in the medial calcaneus: is anywhere safe?

Objective: To redefine the medical calcaneal anatomic safe zone for pin placement with respect to reproducible palpable landmarks.

Design: Anatomic study.

Setting: Medical school anatomy laboratory.

Internet versus mailed questionnaires: a randomized comparison (2).

Background: Low response rates among surgeons can threaten the validity of surveys. Internet technologies may reduce the time, effort, and financial resources needed to conduct surveys.

Objective: We investigated whether using Web-based technology could increase the response rates to an international survey.

Stress examination of supination external rotation-type fibular fractures.

Background: Deltoid incompetence in association with an isolated fibular fracture is assumed to be present if there is medial tenderness, ecchymosis, or substantial swelling. We sought to determine whether these soft-tissue indicators predict deltoid incompetence by comparing such findings with the findings on stress radiographs.

Methods: Over a thirty-two-month period, 138 patients who presented acutely with a Weber type-B supination-external rotation (SE) fibular fracture were evaluated for tenderness (in nine locations), ecchymosis, and swelling.

Soft tissue injuries associated with pelvic fractures.

Significant soft tissue injuries often occur as part of high-energy injuries to the pelvis. These soft tissue injuries must be recognized and considered when implementing a treatment plan if complications are to be minimized. Vigilance in diagnosing open fractures must be maintained.

Interobserver agreement in the application of levels of evidence to scientific papers in the American volume of the Journal of Bone and Joint Surgery.

Background: Since January 2003, all clinical scientific articles published in the American volume of The Journal of Bone and Joint Surgery (JBJS-A) have included a level-of-evidence rating. The aim of the current study was to evaluate the interobserver agreement among reviewers, with varying levels of epidemiology training, in categorizing the levels of evidence of these clinical studies.

Methods: Fifty-one consecutive clinical papers published in the American volume of JBJS were identified by a computerized search of the table of contents from January 2003 through June 2003.

Interrater reliability in grading abstracts for the orthopaedic trauma association.

Only a small proportion of submitted abstracts to the annual meeting of the Orthopaedic Trauma Association can be accepted for podium presentation. Annual program committee members must ensure that the selection of abstracts is free from bias and transparent to investigators. The objectives of this study are to examine the consistency of reviewers in grading abstracts submitted for podium presentations at the 2001 and 2002 Annual Meetings of the Orthopaedic Trauma Association and to evaluate whether the grades of the actual podium presentations at the meeting are consistent with the grades based on abstracts only.

Skeletal injury patterns in older females.

Injury patterns in elderly patients are different from those in younger patients. With recent emphasis on osteoporosis and its effects, we looked at a continuous series of patients from one Level 1 trauma center regarding injury patterns by gender. For all patients older than 65 years, and including all mechanisms, older women were more likely to sustain forearm and wrist fractures than were older men.

Limiting loss to follow-up in a multicenter randomized trial in orthopedic surgery.

Even the best-designed, randomized controlled trials suffer when patients are lost to follow-up. Incomplete follow-up biases the results of a trial when patients who drop out are different from those who complete follow-up. This is exaggerated further when there are differential dropout rates between study groups.

Hierarchy of evidence: differences in results between non-randomized studies and randomized trials in patients with femoral neck fractures.

Introduction: There have been a number of non-randomized studies comparing arthroplasty with internal fixation in patients with femoral neck fractures. However, there remains considerable debate about whether the results of non-randomized studies are consistent with the results of randomized, controlled trials. Given the economic burden of hip fractures, it remains essential to identify therapies to improve outcomes; however, whether data from non-randomized studies of an intervention should be used to guide patient care remains unclear.

Internal fixation compared with arthroplasty for displaced fractures of the femoral neck. A meta-analysis.

Background: The optimal choice for the stabilization of displaced femoral neck fractures remains controversial, with alternatives including arthroplasty and internal fixation. Our objective was to determine the effect of arthroplasty (hemiarthroplasty, bipolar arthroplasty, and total hip arthroplasty), compared with that of internal fixation, on rates of mortality, revision, pain, function, operating time, and wound infection in patients with a displaced femoral neck fracture.

Methods: We searched computerized databases for randomized clinical trials published between 1969 and 2002, and we identified additional studies through hand searches of major orthopaedic journals, bibliographies of major orthopaedic textbooks, and personal files.

Glossary of evidence-based orthopaedic terminology.

As surgeons incorporate the philosophy of evidence-based orthopaedics into patient care, they need to become familiar with common terminology. A glossary of commonly used terms encountered among evidence-based orthopaedic practitioners is presented.

Designing, conducting, and evaluating journal clubs in orthopaedic surgery.

The first record of a journal club was that founded in 1875 by Sir William Osler at McGill University for the purchase and distribution of periodicals to which he could not afford to subscribe as an individual. Evidence-based medicine is becoming an accepted educational paradigm in medical education at various levels. An analysis of the literature related to journal clubs in residency programs in specialties other than orthopaedic surgery reveals that the three most common goals were to teach critical appraisal skills (67%), to have an impact on clinical practice (59%), and to keep up with the current literature (56%).