Finally, practicing orthopedic surgeons, particularly those in subspecialties of orthopedics, will find the book a helpful resource in reassuring them that their treatment in areas outside their subspecialty interest is current and up-to-date. Organization The book is structured similarly to the structure of orthopedic surgery. Natural subspecialization has occurred in orthopedic surgery over the years, which has resulted in some overlap in anatomic areas.
This has resulted in the book having some overlap and some artificial division of subjects. Because of the primarily subspecialization structure, the reader is encouraged to read entire chapters or, for more discrete topics, go directly to the index for information.
For example, the house officer rotating on the pediatric orthopedic service would find reading the pediatric chapter to be a prudent method of developing a baseline knowledge in pediatric orthopedic surgery.
Knee problems, however, might be best approached by looking in the sports medicine chapter or in the adult reconstruction chapter, since these areas overlap, mostly in age of patient. This is a new addition and is an outgrowth of the importance of outcomes in orthopedics. Management of orthopedic problems arising from trauma is covered in Chapter 2, while Chapter 3 deals with sports medicine with an emphasis on the knee and shoulder.
Chapter 4 covers all aspects of spine surgery, including infection of the spine, degenerative spinal problems, spinal deformity, and spinal trauma. Chapter 5 provides comprehensive coverage of tumors in orthopedic surgery, including benign and malignant soft-tissue and hard-tissue tumors. Adult joint reconstruction, including the disorders that lead to joint reconstruction, are covered in Chapter 6.
- Randomised Trial Support for Orthopaedic Surgical Procedures;
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In Chapter 7, infections, with their special implications for orthopedic surgery, are covered. Chapter 8 discusses foot and ankle surgery, and Chapter 9, hand surgery. Chapter 10 covers diseases in orthopedics unique to children. The final two chapters deal with amputation and all aspects of rehabilitation fundamental to orthopedic surgeons in returning patients to full function. Outstanding Features Illustrations have been carefully selected to maximize their benefits in pointing out orthopedic principles and concepts.
The effect of changes in imaging technology on optimal diagnostic studies is emphasized, including cost-effectiveness.
Bone and soft tissue tumor differential diagnoses are simplified by comprehensive tables that categorize tumors by age, location, and imaging characteristics. The molecular basis of the current understanding of tumor etiology is expanded. Concise, current, and comprehensive treatment of the basic sciences underlying the understanding of orthopedic surgery is provided in individual chapters, where pertinent. We are pleased to be able to say, with the concurrence of our coauthors, that these new features added to the information in the previous edition make this edition a significant improvement over the last.
Selected References Elective Orthopaedics by Anthony H C - AbeBooks
Pop-up div Successfully Displayed This div only appears when the trigger link is hovered over. Overview References, to the reader, are like insulin to the diabetic: when needed they are indispensable, but in excess they induce coma. Moreover, when references are simply shovelled into a text in great gobbets, it is hard to resist the suspicion that the author has not read them all, but has copied some from a previous author's list.
The story is told of one author who mischievously included in his list a bogus reference to an obscure foreign journal, and gleefully noted its frequent appearance in future articles. One of the joys of this present book is that the number of references to each topic is very small. Each group of references is followed by a critical assessment, written with balanced judgment and commendable brevity, and how refreshing it is to find authors who read much but write little. In fact, these authors have followed the pattern of the sister work, Selected References in Orthopaedic Trauma, published in Product Details Table of Contents.
Just 17 studies specifically attempted to address this potential source of detection bias in their methodology and was the largest avoidable contributor to the overall high risk of bias across the included studies. When RCTs were analysed against sample size, less than half the total volume of procedures were supported by RCTs with a sample size greater than the median of Though inadequate sample size does not directly influence study bias, underpowered studies are more likely to have a greater rates of type II errors in which studies fail to detect statistically significant treatment effects.
An investigation by Lochner et al into the rates of type II errors of randomised trials involving orthopaedic fracture care showed higher than accepted levels of type II errors and, low mean level of study power . The high proportion of underpowered orthopaedic RCTs may be one of the reasons for the low support rate seen in our study. We acknowledge the limitations of our study. Not subdividing the RCT evidence by indication for the specific procedures in our analysis for example, the removal of implants for pain as opposed to other indications, or cruciate ligament reconstruction for an isolated tear as opposed to a multi-ligamentous injury is a potential limitation of this study as the RCT evidence support for a procedure may be restricted to specific indications.
Given the primary aim of the study was to assess potential differences between available RCT evidence and current clinical practice, an analysis subdividing each of the included procedure groups for indication would have contributed little value to the primary outcome. As our criteria allowed inclusion of supportive RCTs for any indication, however, it is likely that there was a potential overestimation of RCT support for any procedure group. Our study investigated RCT-level evidence exclusively as this study design provides the least biased evidence for the efficacy and safety of an intervention though its ability to deal with confounding .
This does not imply that every operative procedure requires RCT-level evidence to support its efficacy over a non-operative alternative. Large, well-designed prospective cohort studies can adequately minimise bias comparable to that of RCTs  and therefore have acceptable levels of validity in cases where an RCT may not be feasible  , .
Orthopedic Surgery Clerkship
While improvements have occurred in the quantity and to a lesser extent, the quality of surgical research over the past several decades, this study confirms that, consistent with other surgical specialities, the majority of orthopaedic surgical interventions are not based on RCT evidence. The findings of this study are reflections of the current disconnect between trial evidence and orthopaedic surgical practice and its comparison to other specialities.
These findings support the need for better quality RCTs to evaluate the indications for orthopaedic procedures and stakeholder discussions about the lack of support for many procedures currently being performed. Syntax of search strategies for each operative procedure category. Browse Subject Areas? Click through the PLOS taxonomy to find articles in your field. Abstract We investigated the proportion of orthopaedic procedures supported by evidence from randomised controlled trials comparing operative procedures to a non-operative alternative.
Funding: The authors have no support or funding to report. Methods Identification and Selection of Orthopaedic Procedures We reviewed the RCT evidence for commonly performed orthopaedic procedures in three major metropolitan teaching hospitals in southwest Sydney, Australia. Data Extraction and Categorisation Included RCTs were independently assessed in their entirety by two reviewers, and the sample size and population, the specific interventions being compared, primary outcome, primary outcome findings, secondary outcomes, findings of secondary outcomes and the authors' conclusions were identified.
For RCTs where a primary outcome was stated, and the findings demonstrated a statistically significant result in favour of the non-operative treatment or where no significant difference was shown for the stated primary outcome, the study was categorised as being 'not supportive of operative treatment'.
Survey of Intraoperative Bacterial Contamination in Dogs Undergoing Elective Orthopedic Surgery
For RCTs where a primary outcome was not stated but several outcomes were measured, and where the measured outcomes did not consistently demonstrate statistically significant results in favour of operative treatment, the study was categorised as 'not supportive of operative treatment'". Discrepancies were resolved by discussion and arbitrated by a third author if necessary. Data Analysis Results were analysed and presented as: The proportion of the total volume of procedures that were assessed by RCTs; The proportion of the total volume of procedures that were: supported by at least one RCT supported by at least one low risk of bias RCT supported by at least one RCT with sample size greater than or equal to the median sample size of included RCTs Primary analyses were conducted using total procedure volume, as this was a more accurate reflection of surgical volume.
Results A total volume of 9, orthopaedic procedures were performed across the three hospitals in the years , and comprising 91 operative procedure categories. Download: PPT. Figure 1. Flow diagram of searches executed, abstracts screened, full-texts screened and RCTs included.
Table 1. Table 2. Figure 2. Figure 3. Risk of Bias Summary 12 of the 83 included RCTs were assessed as having low risk of bias across the two domains: allocation concealment and blinding of outcome assessment. Figure 4. Risk of bias assessment summary for 83 included RCTs using the Cochrane Collaboration's risk of bias tool. Discussion We reviewed the available RCT evidence in relation to commonly performed orthopaedic procedures in the years , and to establish what proportion of these procedures was supported by RCT evidence.
Supporting Information. Appendix S1.
Selected References In Elective Orthopaedics
List of procedures performed ordered according to frequency. Appendix S2. Appendix S3. List of included and excluded RCTs after full-text assessment. Appendix S4. Characteristics of included RCTs. Appendix S5. Checklist S1. References 1. BMJ 71— View Article Google Scholar 2. Crowther H, Lipworth W, Kerridge I Evidence-based medicine and epistemological imperialism: narrowing the divide between evidence and illness.
J Eval Clin Pract — View Article Google Scholar 3. Ghosh AK Clinical applications and update on evidence-based medicine. J Assoc Physicians India — View Article Google Scholar 4. Lancet — View Article Google Scholar 5.
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