Evidence vs Experience in Trauma Surgery
Journal Title: TRAUMA INTERNATIONAL - Year 2018, Vol 0, Issue 0
Abstract
As a part of Traumacon, over a decade, we have closely observed the changing paradigm of Trauma practice and perception and importance of means of trauma education and learning. A recent Editorial in Journal of Orthopaedic Case reports pointed toward this ongoing struggle between Evidence based medicine and Experience based medicine. Thakkar et al pointed towards this effect being more pronounced in countries like India [1]. We too have seen this development in major trauma conferences across the country. There is one major difference on how this conflict present in Orthopaedic trauma. Fractures and related injuries have varied presentations and many a times need individual customised treatment protocols. Evidence based Medicine with its rigors and methodology, many a times falls short in addressing these issues directly. Although we can have good evidence in terms of use as modality or against it, but selection of the modality poses practical difficulties. For example, good body of evidence exists to support use of intramedullary nails for intertrochanteric fractures, but at the same time good evidence alrso exists for use of dynamic hip screw for the same. To choose between the two implants depends on two factors, patients’ factors and also surgeons’ factors. Patients factors are helped by Evidence based medicine where factors like age, bone quality, fracture personality and stability can help in decision making. However, surgeon factor becomes more important in countries like India and specially in rural India where many surgeons are well versed in Dynamic Hip screw and are more comfortable in doing a DHS for these patients. Are they doing wrong or are they doing an outdated surgery? Absolutely not, they are completely justified in performing a surgery in which they have garnered exception skills over decades. And it perfectly fits the principles of evidence-based medicine as surgeon factor is one of the most important pillars of EBM, patient factor and current literature being the other two. This conflict between evidence based medicine and experience based medicine basically arises due to misinterpretation or narrow vision perception of Evidence. Evidence based medicine does not equate to published literature and journal articles only. It has to be clearly understood that EBM is an amalgamation of Literature, patient factors and surgeon factors and all three pillars are equally important. Technically there is no conflict between the two, the conflict only exists in our varied perception of both. EBM urges us to use the best of Literature, the best of our clinical experience and base our decision making taking into account the patient factors. There is no easy way to do this, but it complete relies on our Experience with Evidence based medicine. In this trauamcon too, we have tried to balance both evidence based medicine and experience based medicine and stitched together a program which does justice to both Trauma International is in its fourth year now and is successfully published every four month and we will urge all of you to submit to Trauma International and add to our Evidence base Best wishes and regards Dr. Sushrut Babhulkar Dr. Ashok Shyam
Authors and Affiliations
Sushrut Babhulkar, Ashok K. Shyam
Keywords
Related Articles
- EP ID EP561835
- DOI -
- Views 126
- Downloads 0
Evidence vs Experience in Trauma Surgery
As a part of Traumacon, over a decade, we have closely observed the changing paradigm of Trauma practice and perception and importance of means of trauma education and learning. A recent Editorial in Journal of Orthopaed...
A Neglected Case of Bilateral Hip Fractures and Other Fractures with Delayed Diagnosis of Hyperparathyroidism as Cause
Introduction: Primary hyperparathyroidism is a disease characterized by hypercalcemia attributable to autonomous overproduction of PTH ParaThyroid Hormone.Primary hyperparathyroidism PHPT is prevalent in approximately 1%...
A Rare and Atypical Case Report of Combined Rupture of Patellar Tendon, Anterior Cruciate Ligament, Medial Collateral ligament, and Lateral Meniscus Managed Operatively
Introduction: Extensor mechanism disruption with other ligament injuries at knee is rare. Rupture of the patellar tendon (PT) usually occurs at the inferior pole of patella leading to proximal retraction of 3–5 cm due to...
Decision Making in Acetabulum Fractures – When to Operate and When Not to?
he complexity of acetabulum fractures has always been challenging to the operating surgeon. In the past 50 years, following pioneering work by LeTournel and Judet, there is better clarity to the treating surgeon regardin...
Biological dynamic condylar screw fixation for management of Peritrochanteric hip fractures
Introduction: Inspite of routine encounters, hip fractures have the capacity to perplex even experienced orthopaedic surgeons at times. Management of these fractures has evolved with time and soft tissue preserving techn...