What do you guys think? is ortho really THAT BAD in terms of EBM? will we see less surgeries in the future?

[Doc mu]

Summary of the video:
The first study looked at the top 30 most commonly performed procedures in ortho found 3 low risk of bias RCTS ONLY
The second was for MSK pain procedures - no LRB RCTs

So most of orthopedic procedures taken as standard nowadays have a very weak evidence base, does that mean that we will see far less ortho procedures in the future with far more stringent indications? especially if insurance companies catch up and stop reimbursing procedures that don't have a strong evidence base?

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[Vandalia]

You already asked this question a little under a year ago:

"this study confirms that the majority of orthopaedic surgical interventions are not based on RCTs" - thoughts??

https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0096745#pone-0096745-t002 This study comes to the conclusion that MANY of the most commonly performed orthopedic procedures are not based on high quality RCTs, what does this mean for the future of ortho? will we see less ortho...

forums.studentdoctor.net

The answers are the same. You don't need to do randomized trials to know you need to fix a compound fracture.

 

[Doc mu]

You already asked this question a little under a year ago:

"this study confirms that the majority of orthopaedic surgical interventions are not based on RCTs" - thoughts??

https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0096745#pone-0096745-t002 This study comes to the conclusion that MANY of the most commonly performed orthopedic procedures are not based on high quality RCTs, what does this mean for the future of ortho? will we see less ortho...

forums.studentdoctor.net

The answers are the same. You don't need to do randomized trials to know you need to fix a compound fracture.

Time flies, I guess i got caught up in the video and decided to share ASAP.
How did you remember that old thread from a year ago if you don't mind me asking? 😛

As for the fx, the same was said about vertebroplasties, meniscectomies for degenerative meniscal tears, arthoscopic knee debridement...etc
We need evidence to know things work no?
In extreme cases like compound Fx, severely dislocated fx...etc, i would agree, but that is not what the general ortho is doing

 

[DNC127]

Time flies, I guess i got caught up in the video and decided to share ASAP.
How did you remember that old thread from a year ago if you don't mind me asking? 😛

As for the fx, the same was said about vertebroplasties, meniscectomies for degenerative meniscal tears, arthoscopic knee debridement...etc
We need evidence to know things work no?
In extreme cases like compound Fx, severely dislocated fx...etc, i would agree, but that is not what the general ortho is doing

Those procedures you mention are a small percentage of ortho surgeries.

Yes, general orthopaedic surgeons all treat open fractures, and fracture dislocations. all the time. Please don’t talk about things you have NO IDEA. about

 

[Doc mu]

Those procedures you mention are a small percentage of ortho surgeries.

Yes, general orthopaedic surgeons all treat open fractures, and fracture dislocations. all the time. Please don’t talk about things you have NO IDEA. about

meniscectomy is the most common ortho procedure after TKA and THA source: Use of the National Surgical Quality Improvement Program in Orthopaedic Surgery (nih.gov)

Most fractures with the profile i am talking about (compound, severely dislocated...etc) get shafted to level 1 trauma centers where i am at, General orthos only see low-mid energy trauma

 

[Vandalia]

profile i am talking about (compound, severely dislocated...etc) get shafted to level 1 trauma centers where i am at, General orthos only see low-mid energy trauma

Not in the real world.

Do you really think a fracture is going to be flown a couple of hours for treatment?

 

[bic_atlantis]

Dude are you anti-ortho or something? Why do u keep such a close tab in similar stories?

 

[Doc mu]

Dude are you anti-ortho or something? Why do u keep such a close tab in similar stories?

Quite the contrary ortho is top 2 on my list of potential specialties, I am just a bit neurotic which is why such things concern me when it comes to the future of a potential specialty

 

[DarkHorizon]

Quite the contrary ortho is top 2 on my list of potential specialties, I am just a bit neurotic which is why such things concern me when it comes to the future of a potential specialty

If you like Ortho, then what’s the issue? Ortho is going nowhere. That video points out to mostly arthroscopic procedures. Do a trauma or joints fellowship. THA/TKA are the best surgeries in all of medicine. Ortho trauma is very much “needed”, as far as nature of surgeries. Break your femur and come back and tell us how nonoperative treatment went for you.

 

[DarkHorizon]

Time flies, I guess i got caught up in the video and decided to share ASAP.
How did you remember that old thread from a year ago if you don't mind me asking? 😛

As for the fx, the same was said about vertebroplasties, meniscectomies for degenerative meniscal tears, arthoscopic knee debridement...etc
We need evidence to know things work no?
In extreme cases like compound Fx, severely dislocated fx...etc, i would agree, but that is not what the general ortho is doing

You have no idea what general Ortho is doing, you’re reading Random studies and watching random videos and drawing your own conclusions.

 

[Doc mu]

You have no idea what general Ortho is doing, you’re reading Random studies and watching random videos and drawing your own conclusions.

I am trying to determine what a general ortho is supposed to be doing via studies, is there consensus as to what general orthos do? because everything i have read points to no....
However studies like this are a step in the right direction: The Core Competencies for General Orthopaedic Surgeons : JBJS
Very nice read on the topic btw

 

[Doc mu]

If you like Ortho, then what’s the issue? Ortho is going nowhere. That video points out to mostly arthroscopic procedures. Do a trauma or joints fellowship. THA/TKA are the best surgeries in all of medicine. Ortho trauma is very much “needed”, as far as nature of surgeries. Break your femur and come back and tell us how nonoperative treatment went for you.

So you think arthroscopy will be seeing changes in the near future?

 

[DarkHorizon]

I am trying to determine what a general ortho is supposed to be doing via studies, is there consensus as to what general orthos do? because everything i have read points to no....
However studies like this are a step in the right direction: The Core Competencies for General Orthopaedic Surgeons : JBJS
Very nice read on the topic btw

These studies don’t really prove anything, general Orthos in the US do whatever they feel comfortable with and whatever they think their patients need. You’re reading way too much into this topic. If you like Ortho, go for it. Stop posting here asking us to affirm that orthos are doing unnecessary procedures and what the future holds. We’ve already answered this before, no one has a crystal ball. My practice is trauma and joints, and I know that my services are heavily needed and patients are extremely grateful. Given how you’re so hung up on this, I’d suggest doing something else and stop worrying about Ortho altogether.

 

[OrthoTraumaMD]

meniscectomy is the most common ortho procedure after TKA and THA source: Use of the National Surgical Quality Improvement Program in Orthopaedic Surgery (nih.gov)

Most fractures with the profile i am talking about (compound, severely dislocated...etc) get shafted to level 1 trauma centers where i am at, General orthos only see low-mid energy trauma

The correct term is open fracture, not compound fracture. And level 2 and even level 3 centers treat open fractures all the time.

 

[ceilingfan019]

Lmao "compound fracture"... should probably update your ortho lingo if you're considering it. Not every open fracture is the same. Not every meniscectomy is the same. Not every trauma is the same. Your generalizations show that you haven't spent much time around ortho. I would suggest you go shadow and ask questions to people in your area rather than to an online community of ortho docs.

Also lol at the NSQIP reference.