Education And Debate

Recent Advances: Orthopaedic and trauma surgery

BMJ 1995; 310 doi: (Published 08 April 1995) Cite this as: BMJ 1995;310:917
  1. Christopher J K Bulstrode, consultant in trauma and orthopaedic surgerya
  1. a Nuffield Department of Orthopaedic Surgery, University of Oxford, John Radcliffe Hospital, Oxford OX3 9DU

    Over the past few years there have been enormous changes in orthopaedic and trauma surgery, but whether they are also advances is not known. Like every other clinical specialty this one desperately lacks the tools, the will, and the resources to assess whether each change is an advance or merely another passing fashion.

    In this article I will review the major changes which have taken place in musculoskeletal surgery and point out where they most urgently need assessing.

    Trauma surgery

    Trauma surgery continues to dominate the workload of most orthopaedic surgeons, encroaching on resources needed for elective surgery. Fractured neck of femur remains the bread and butter of trauma. The numbers continue to rise,1 but the average length of stay in many units has fallen.2 This is possibly through increased liaison between geriatricians, orthopaedic surgeons, and the community, but it may also reflect the fairly new attitude that acute hospital beds are an expensive resource and that there is no worse place for an elderly patient than in bed in hospital.3 Patients may be moving from acute beds more rapidly, but perhaps they are simply transferring to non-acute beds, where they may actually stay much longer.4 The faster turnover of acute trauma beds may not be serving patients or even the health service as well as it might first seem. There is a great need for a large multicentre study to look at (a) whether early surgery improves the long term outcome, (b) the effect of the type of fixation used and the experience of the operator (most of these operations are performed by junior surgeons), and (c) the cost-benefit of rehabilitation performed in an acute hospital, in a rehabilitation unit, or at home.


    The management of major trauma at its earliest stages has changed beyond recognition with …

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