Editorial – Open Fracture of Lower Limb Symposium

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Vol 4 | Issue 1 | May – Aug 2018 | page:3 |  Dr. S. Rajasekaran

doi-10.13107/ti.2018.v04i01.055

Author:  S Rajasekaran [1], 

[1] Department of Orthopaedics, Trauma & Spine Surgery Ganga Hospital, 313, Mettupalayam road, Coimbatore, India.

Address of Correspondence
Dr. S Rajasekaran,
Director & Head of Dept, Department of Orthopaedics, Trauma & Spine Surgery, Ganga Hospital, 313, Mettupalayam road, Coimbatore, India.
Email: rajasekaran.orth@gmail.com

Editorial: Open Fracture of Lower Limb Symposium

The management of open fractures of lower limbs present special challenges as they have increased chances of infection, number of surgical procedures, a high rate of complications, huge cost of treatment and very often a poor functional outcome. The treating surgeon is often faced with many difficulties in decision making, starting from the ability of salvage and extending on to the timing of surgeries and the nature of reconstruction of both bone and soft tissue defects. Although salvage is preferable, failed attempts at salvage must be avoided as secondary amputations can lead to huge financial, social, psychological and emotional disturbance to patients and their relatives. Advances in the design of lower limb prosthesis have significantly improved the chances for a painless and functional lower limb and so the result of treatment must be better than what is offered by modern prosthesis.
A thorough knowledge of assessment of these challenging injuries and protocols in management is required. These injuries are often a part of a polytrauma situation and so a team approach is absolutely essential. Tissue damage and loss involve both soft tissues and bone to varying extent and hence an ‘Ortho-plastic’ approach is essential right from the time of debridement. The entire team must be aware of the proper timing of surgery and the sequence of reconstructive procedures as any mis-judgement or faulty decisions can burn bridges and lead to poor outcomes or even amputation.
This volume has a compilation of a few articles summarizing the philosophy of treatment of these injuries at Ganga Hospital. They describe in detail the primary treatment and the sequence of surgical events which will lead to a successful outcome. I am sure that this will be of use to surgeons in training who are involved in the management of these injuries.

How to Cite the article: S Rajasekaran. Open Fracture of lower limb Symposium. Trauma International. May-Aug 2018;4(1):3.

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Editorial – Evidence vs Experience in Trauma Surgery

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Vol 4 | Issue 1 | May – Aug 2018 | page:1-2 |  Dr. Sushrut Babhulkar, Dr. Ashok K. Shyam

doi- 10.13107/ti.2018.v04i01.054

Author:  Sushrut Babhulkar [1], Ashok K. Shyam [2,3].

[1] Sushrut Institute of Medical Sciences, Research Centre & Post-Graduate Instt of Orthopedics, Central Bazar Road, Ramdaspeth, Nagpur, INDIA 400 010
[2] Indian Orthopaedic Research Group, Thane, India.
[3] Sancheti Institute for Orthopaedics & Rehabilitation, Pune, India.

Address of Correspondence
Dr. Ashok Shyam
Sancheti Institute for Orthopaedics & Rehabilitation,  Shivajinagar, Pune, India
Email: drashokshyam@gmail.com

Editorial: 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 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

References

1. Thakkar CJ, Shyam A. Evidence-based medicine: Why there is a low acceptance in countries like India?. Journal of Orthopaedic Case Reports 2017 Nov- Dec;7(6):1-2

How to Cite the article: Babhulkar S, Shyam AK. Evidence vs Experience in Trauma Surgery. Trauma International. May-Aug 2018;4(1):1-2

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