Distal Radial Fractures

Distal Radial Fractures
OrthoJOE
Distal Radial Fractures
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Episode 7 March 15, 2021 00:18:09

Hosted By

Mohit Bhandari, MD Marc Swiontkowski, MD

Show Notes

Welcome to the OrthoJOE podcast with Dr. Marc Swiontkowski and Dr. Mohit Bhandari. In this episode of OrthoJOE, Marc and Mo discuss the RCTs (or randomized control trials) on common injuries like distal radial fractures. There is a huge amount of work involved in these. Should our focus be elsewhere? Is there such a thing as too many RCTs on the same topic? 

Marc and Mo also talk about the data and their findings in recent scientific journals, including their own JBJS and Orthoevidence articles. "Cost-effectiveness studies'' are increasingly popular, with submissions doubling every 18 months. Orthopaedic surgeons must "own the bone" when treating distal radial fractures, which should be seen as a sentinel event for investigating overall bone health. 

If you have any comments, questions, or topics you would like us to cover, please feel free to reach out so we can read your messages and possibly answer your questions during the next episode of OrthoJOE. We are currently working on a better mailbag system. However, in the meantime, you can contact us through our respective websites (MyOrthoEvidence and JBJS). 

Talking Points:

  • RCTs on distal radial fractures
  • The cost-effectiveness of certain studies
  • Getting the appropriate dialogue going
  • The upsides and downsides to “expertise-based trials”
  • Novel angles for future trials
  • The AOA’s “Own the Bone” Program and focusing on poor bone quality

Resources/Links:

Other Episodes

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July 19, 2021

The Fragility Index: Why is it Important to the Practicing Orthopaedic Surgeon?

In this instructive episode, Mo and Marc focus on the concept of the Fragility Index—a method for evaluating the robustness of statistically significant dichotomous outcomes in RCTs—and discuss why this concept is relevant to practicing orthopaedic surgeons, who must routinely make real decisions in the clinic and OR based on their interpretation of the orthopaedic literature.  OrthoJOE Mailbag: feedback, comments, and suggestions from our audience can be sent to [email protected] Links: OrthoEvidence. Fragility Index: How robust are your results? OE Original. 2021;4(5):2. Available from: https://myorthoevidence.com/Blog/Show/127 Ekhtiari S, Gazendam AM, Nucci NW, Kruse CC, Bhandari M. The Fragility of Statistically Significant Findings From Randomized Controlled Trials in Hip and Knee Arthroplasty. J Arthroplasty. 2021 Jun;36(6):2211-2218.e1. doi: 10.1016/j.arth.2020.12.015. Epub 2020 Dec 13. PMID: 33390336. https://pubmed.ncbi.nlm.nih.gov/33390336/ ...

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December 30, 2020

Current Issues with Drs. Bhandari and Swiontkowski

Welcome to the OrthoJOE podcast with Dr. Marc Swiontkowski and Dr. Mohit Bhandari. In this second episode of OrthoJOE, we’ll be talking about our background in orthopedics, the purpose and mission for our podcast, and topics we cover in both of our publications including the use of antibiotic cement in arthroplasty, registry data, randomized trials, and trial numbers. We also discuss how different trials covering the same subject matter can yield such different results. Dr. Marc Swiontkowski is an orthopedic trauma surgeon at the TRIA Orthopedic Center Bloomington. He is the editor-in-chief of the Journal of Bone and Joint Surgery. He’s also an active researcher sponsored by the National Institutes of Health. Dr. Mohit Bhandari is a professor and academic head of the division of Orthopedic Surgery at McMaster University in Ontario. He holds the Canadian Research Chair in evidence-based orthopedics. If you have any comments, questions, or topics you would like us to cover, please feel free to reach out so we can read your messages and possibly answer your questions during the next episode of OrthoJOE. Talking Points: The use of antibiotic cement in arthroplasty The biggest challenge in registry data  Subject numbers and other necessities for trials Knee replacement and hip replacement trials ...

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00:18:56

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February 15, 2021

Femoral Neck Fracture Evidence

Welcome to the OrthoJOE podcast with Dr. Marc Swiontkowski and Dr. Mohit Bhandari. In this episode of OrthoJOE, Marc and Mo are talking about the choice of a unipolar or bipolar prosthesis design for displaced femoral neck fractures which are treated with hemiarthroplasty. They discuss randomized clinical trials (scientific approach to control bias) vs registry data (real world). They also have a lively discourse about revision rates. If you have any comments, questions, or topics you would like us to cover, please feel free to reach out so we can read your messages and possibly answer your questions during the next episode of OrthoJOE. Talking Points: Orthoevidence article: “Unipolar vs bipolar hemiarthroplasty similar in elderly displaced femoral neck fractures in elderly individuals” Lessons from Mo’s large random control trial concerning fractures The debate about total versus hemiarthroplasty The advantage of a total hip replacement The statistics of the trial The need for a repository of data Clinical decision-making about cementification and revision Resources/Links: Farey JE, Cuthbert AR, Adie S, Harris IA. “Revision Risk After Unipolar or Bipolar Hemiarthroplasty for Femoral Neck Fractures: An Instrumental Variable Analysis of 62,875 Procedures from the Australian Orthopaedic Association National Joint Replacement Registry.” J Bone Joint Surg Am. 2021 Feb 3;103(3):195-204. doi: 10.2106/JBJS.20.00486. PMID: 33208595. https://europepmc.org/article/med/33208595  HEALTH Investigators, Bhandari M, Einhorn TA, Guyatt G, Schemitsch EH, Zura RD, Sprague S, Frihagen F, Guerra-Farfán E, Kleinlugtenbelt YV, Poolman RW, Rangan A, Bzovsky ...

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00:14:43