Clinical Review Recent advances


BMJ 2001; 322 doi: (Published 14 April 2001) Cite this as: BMJ 2001;322:902
  1. C G Moran, consultant trauma and orthopaedic surgeon (,
  2. L J Tourret, specialist registrar in orthopaedics
  1. Department of Trauma and Orthopaedics, University Hospital, Queen's Medical Centre, Nottingham NG7 2UH
  1. Correspondence to: CG Moran

    Trauma and orthopaedics have seen many changes over the past 20 years. The next 20 promise even greater advances, particularly in the areas of materials science, computer aided manufacturing technology, and molecular biology. In addition to technical advances there have been changes in the provision of care, such as the greater subspecialisation of surgeons and improvements in the organisation of trauma and oncology services. Perhaps the most important change is the increase in evidence based practice which uses studies of patients' outcomes.


    It has been difficult to select specific advances to focus on within such a diverse specialty. We have tried to identify developments in common areas of practice, such as trauma, paediatrics, and joint replacement surgery. A computer based literature search and search of abstracts of presentations at conferences was used to identify the evidence that supports the changes made in current practice. Some of the advances, such as the use of flexible nailing in children's fractures, are already well established in some countries. Others, such as using gene therapy to enhance the repair of fractures, are still at the laboratory stage but have the potential to revolutionise practice. The era of the “orthopaedic molecular biologist” may soon be a reality.

    Treating younger patients

    Autologous chondrocyte transplantation

    Articular cartilage is vulnerable to injury and has poor potential for repair so damage can lead to arthritis many years after injury. 1 2 In elderly people, joint replacement surgery has revolutionised the treatment of arthritis, but the management of damage to articular cartilage in young patients remains a problem.

    The ideal treatment would replace damaged articular cartilage, restore joint function, and prevent the development of arthritis. Fibrocartilage is unable to withstand the high mechanical loads within a joint and only hyaline cartilage, which has predominantly type II collagen, has the potential for good, long term results. Transplantation …

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