Bone Health

SIGN Guideline Management of Osteoporosis (pdf file)

Summary: Antibiotics are effective in preventing early infection in open fractures of the limbs Wound and bone infections are common complications following open fractures of the limbs. For more than 20 years, in developed countries, the use of antibiotics has been a part of a standard management protocol that also includes irrigation, surgical debridement, and stabilisation when indicated. The review of trials found that antibiotics are effective in decreasing the incidence of wound infections, as compared to no antibiotics or placebo. No studies on bone infection or long-term morbidity were identified. (Cochrane Review)
Gosselin RA, Roberts I, Gillespie WJ. Antibiotics for preventing infection in open limb fractures. Cochrane Database of Systematic Reviews 2004, Issue 1. Art. No.: CD003764.

Antibiotic Prophylaxis for Dental Patients with Total Joint Replacements, Antibiotic Prophylaxis for Urological Patients with Total Joint Replacements, Cell- and Tissue-Engineered Products, Commitment to Excellence, "CDH" Should be "DDH", Family Violence Guidelines for Orthopaedic Utilization Review, Implant Device Recalls, The Importance of Good Communication in the Physician-Patient Relationship, Orthopaedic Medical Testimony, Package Pricing, Physicians' Responsibilities in Regard to Violence, Preventing the Transmission of Bloodborne Pathogens, Sideline Preparedness for the Team Physician Team Physician Consensus Statement, The Scope of Orthopaedic Practice in Managed Care Arrangements, Thermography Use of Lasers in Orthopaedic Surgery, Use of Musculoskeletal Tissue Allografts, The Use of Prophylactic Antibiotics in Orthopaedic Medicine and the Emergence of Vancomycin-Resistant Bacteria, Wrong-Site Surgery.

Users’ guide to the surgical literature: how to use a systematic literature review and meta-analysis
Mohit Bhandari, MD, MSc; P.J. Devereaux, MD; Victor Montori, MD, MSc; Claudio Cinà, MD, MSc; Ved Tandan, MD, MSc; Gordon H. Guyatt, MD, MSc; for the Evidence-Based Surgery Working GroupFrom the Surgical Outcomes Research Centre, Department of Surgery, St. Joseph’s Healthcare Hamilton and McMasterUniversity, and the Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ont.

Antibiotic Prophylaxis for Dental Patients with Total Joint Replacements American Dental Association; American Academy of Orthopaedic Surgeons An expert panel of dentists, orthopaedic surgeons and infectious disease specialists, convened by the American Dental Association (ADA) and the American Academy of Orthopaedic Surgeons (AAOS) performed a thorough review of all available data to determine the need for antibiotic prophylaxis to prevent hematogenous prosthetic joint infections in dental patients who have undergone total joint arthroplasties.

Acetaminophen for osteoarthritis (Cochrane Review) Towheed TE, Maxwell L, Judd MG, Catton M, Hochberg MC, Wells G The Cochrane Database of Systematic Reviews 2006, Issue 1. Art. No.: CD004257.pub2. Authors' conclusions: The evidence to date suggests that NSAIDs are superior to acetaminophen for improving knee and hip pain in people with OA. The size of the treatment effect was modest, and the median trial duration was only six weeks, therefore, additional considerations need to be factored in when making the decision between using acetaminophen or NSAIDs. In OA subjects with moderate-to-severe levels of pain, NSAIDs appear to be more effective than acetaminophen.

SIGN Publication No. 45 ISBN 1899893 22 9 Published July 2000

Antithrombotic Therapy. SIGN Guideline. SIGN Publication No. 36 ISBN 1899893 76 8 Published March 1999

Bias towards publishing positive results in orthopedic and general surgery: a patient safety issue? Erik A Hasenboehler , Imran K Choudhry , Justin T Newman , Wade R Smith , Bruce H Ziran and Philip F Stahel
Patient Safety in Surgery 2007, 1:4
Conclusions There is a disproportionately high number of articles reporting positive results published in the surgical literature. A bias towards publishing positive data will systematically overestimate the clinical relevance of treatment effects by disregarding important information derived from unpublished negative studies. This "publication bias" remains an area of concern and may affect the quality of care of patients undergoing surgical procedures.

The Cochrane Musculoskeletal Group provides systematic reviews of the effects of healthcare interventions for musculoskeletal diseases.

The Cochrane Injuries Group provides systematic reviews of the effects of healthcare interventions for injuries. OWL ed. There used to be a Musculoskeletal Injuries group. Has that gone?

Conservative management following closed reduction of traumatic anterior dislocation of the shoulder (Cochrane Review) Handoll HHG, Hanchard NCA, Goodchild L, Feary J The Cochrane Database of Systematic Reviews 2006, Issue 1. Art. No.: CD004962. Authors' conclusions: There is a lack of evidence from randomised controlled trials to inform the choices for conservative management following closed reduction of traumatic anterior dislocation of the shoulder.Sufficiently powered, good quality, well reported randomised controlled trials with long-term surveillance of conservative management are required. In particular, trials examining the type and duration of immobilisation would be useful.

Early Management of Patients with a Head Injury. SIGN Guideline
SIGN Publication No. 46 ISBN 1899893 27 X Published August 2000

Update in eMJA of 1996 study "How best to fix broken hips" (qv) Michael N Chilov, Ian D Cameron and Lyn M March MJA 2003; 179 (9): 489-493

IN New Frontiers in Geriatric Research.An attempt to to develop a research agenda specifically aimed at enhancing the quality of care of the elderly patients