EVIDENCE for FRCS (Orthopaedics)
- CMCJ Osteoarthritis Treatment:
Study: “Trapeziectomy alone, with tendon interposition or with ligament reconstruction?: A randomized prospective study”
Journal: Journal of Hand Surgery
Authors: Davis et al., 1997
Summary: This study evaluated the effectiveness of different surgical techniques for treating carpometacarpal joint (CMCJ) osteoarthritis. Patients were randomized to receive either trapeziectomy alone, trapeziectomy with tendon interposition, or trapeziectomy with ligament reconstruction. The results showed no significant difference in pain relief, hand function, or thumb strength among the three groups.
Clinical Implication: Surgeons can consider any of these three surgical options for CMCJ osteoarthritis, as they provide comparable outcomes in terms of pain relief and functional improvement.
- Radial Nerve Palsy with Humeral Fracture:
Study: “Radial nerve palsy associated with fractures of the shaft of the humerus: A systematic review”
Journal: Journal of Bone and Joint Surgery Br.
Authors: Giannoudis et al., 2005
Summary: This systematic review compared the outcomes of patients with radial nerve palsy associated with humeral shaft fractures managed expectantly versus those explored early. The findings indicated no significant difference in the final results between the two groups. This suggests that initial expectant treatment does not adversely affect nerve recovery and can avoid unnecessary surgeries.
Clinical Implication: Initial expectant management can be a safe approach for radial nerve palsy in humeral shaft fractures, potentially reducing the need for early surgical intervention.
- Scaphoid Fracture Management:
Study: “Percutaneous vs. Closed management of Waist fracture”
Journal: Journal of Bone and Joint Surgery
Authors: McQueen et al., 2008
Summary: The study compared early return to work times between percutaneous fixation and closed management of scaphoid waist fractures. Results indicated that patients treated with percutaneous fixation returned to work significantly earlier (9.2 weeks) compared to those managed non-operatively (13.4 weeks).
Clinical Implication: Percutaneous fixation can facilitate a quicker return to work for patients with scaphoid waist fractures, making it a preferred treatment option for those seeking rapid recovery.
- Exeter Total Hip Replacement (THR):
Study 1: “The Exeter Universal Hip Replacement for the young patient – 10 to 17 years follow-up”
Journal: Clinical Orthopaedics and Related Research
Authors: Lewthwaite et al., 2008
Summary: This long-term follow-up study assessed the performance of the Exeter Universal Hip Replacement in young patients. The survivorship of the stem and cup from all causes was 92.7% over an average of 12.5 years. The stem survivorship from aseptic loosening was 100%.
Clinical Implication: The Exeter Universal Hip Replacement demonstrates excellent long-term performance in young patients, with a low rate of aseptic loosening.
Study 2: “The Exeter Universal cemented femoral component at 15 to 17 years: an update on the first 325 hips”
Journal: Journal of Bone and Joint Surgery Br.
Authors: Carrington et al., 2009
Summary: This update reported a 100% survivorship for the femoral component and a 90.4% survivorship for the acetabular component at 17 years with an endpoint of revision for aseptic loosening.
Clinical Implication: These results further support the durability and reliability of the Exeter Universal cemented femoral component for long-term use in hip replacements.
- ACL Reconstruction Timing:
Study: “The incidence of secondary pathology after anterior cruciate ligament rupture in 5086 patients requiring ligament reconstruction”
Journal: Journal of Bone and Joint Surgery Br. (Bone Joint J)
Authors: Sri Ram et al., 2013
Summary: The study evaluated 5086 patients with a mean age of 30 years. It found that delaying ACL reconstruction surgery beyond 12 months significantly increased the risk of medial meniscal and chondral injuries.
Clinical Implication: ACL reconstruction should ideally be performed within five months of injury, especially in younger patients, to minimize secondary damage.
- Proximal Tibial Osteotomy:
Study: “Proximal tibial osteotomy. A critical long-term study of eighty-seven cases”
Journal: Journal of Bone and Joint Surgery Am.
Authors: Coventry et al., 1993
Summary: The study highlighted the importance of postoperative valgus angulation and weight in the survival of proximal tibial osteotomies. Patients with >8 degrees valgus angulation and lower weight had higher survival rates at 5 and 10 years compared to those with <8 degrees and higher weight.
Clinical Implication: For successful long-term outcomes, proximal tibial osteotomy should achieve at least 8 degrees of valgus angulation, and patients should maintain an optimal weight.
- Calcaneal Fracture Management:
Study: “Operative compared with nonoperative treatment of displaced intra-articular calcaneal fractures: a prospective, randomized, controlled multicenter trial”
Journal: Journal of Bone and Joint Surgery Am.
Authors: Buckley et al., 2002
Summary: This trial compared operative and nonoperative treatments for displaced intra-articular calcaneal fractures. Overall, functional results were equivalent, but operative treatment showed significantly better outcomes in specific groups after excluding patients receiving Workers’ Compensation.
Clinical Implication: Surgical treatment can be beneficial for certain patients with displaced intra-articular calcaneal fractures, particularly when excluding confounding factors like Workers’ Compensation.
- Femoral Neck Fracture in Young Adults:
Study: “Delayed internal fixation of fractures of the neck of the femur in young adults”
Journal: Journal of Bone and Joint Surgery Br.
Authors: Upadhyay et al., 2004
Summary: This study assessed the outcomes of delayed internal fixation of displaced intracapsular neck of femur (NOF) fractures in patients aged 15-50. Major factors affecting nonunion were posterior comminution, poor reduction, and improper screw placement. A delay of more than 48 hours did not affect union rates or avascular necrosis (AVN) development.
Clinical Implication: Timely fixation remains critical, but a delay of up to 48 hours does not necessarily compromise outcomes in young adults with displaced intracapsular NOF fractures.
- THR vs. Internal Fixation for Femoral Neck Fractures in the Elderly:
Study: “Internal fixation compared with total hip replacement for displaced femoral neck fractures in the elderly”
Journal: Journal of Bone and Joint Surgery Br.
Authors: Tidemark et al., 2003
Summary: This randomized controlled trial compared internal fixation (IF) and total hip replacement (THR) in elderly patients with displaced femoral neck fractures. THR showed better hip function and fewer revisions than IF.
Clinical Implication: THR is preferable for elderly, healthy patients with displaced femoral neck fractures due to better functional outcomes and lower complication rates.
- Total Hip Replacement vs. ORIF for Femoral Neck Fractures:
Study: “Total Hip Replacement Versus Open Reduction and Internal Fixation of Displaced Femoral Neck Fractures”
Journal: Journal of Bone and Joint Surgery Am.
Authors: Ghazi et al., 2012
Summary: Over 17 years, this study found that THR provided better hip function and fewer reoperations compared to ORIF in healthy elderly patients with displaced femoral neck fractures, without increasing mortality.
Clinical Implication: THR should be considered over ORIF for displaced femoral neck fractures in elderly patients due to superior long-term outcomes.
- Timing of Reduction and Stabilization in SUFE:
Study: “The timing of reduction and stabilization of the acute, unstable, slipped upper femoral epiphysis”
Journal: Journal of Bone and Joint Surgery Br.
Authors: Phillips et al., 2001
Summary: In this study of 100 patients with slipped upper femoral epiphysis (SUFE), early reduction and stabilization within 24 hours for unstable slips significantly reduced the risk of avascular necrosis (AVN).
Clinical Implication: Early intervention within 24 hours is crucial for unstable SUFE to minimize the risk of AVN.
- Legg-Calve-Perthes Disease Treatment Outcomes:
Study: “Legg-Calve-Perthes disease. Part II: Prospective multicenter study of the effect of treatment on outcome”
Journal: Journal of Bone and Joint Surgery Am.
Authors: Herring et al., 2004
Summary: This prospective multicenter study of 438 patients assessed outcomes based on treatment methods. The lateral pillar classification and age at onset strongly correlated with outcomes, with surgery being more beneficial for patients older than 8 years with certain classifications.
Clinical Implication: Treatment for Legg-Calve-Perthes disease should consider the patient’s age and lateral pillar classification to optimize outcomes.
