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A-1207 Evidence
Janos Rupnik, Hungary
Thursday, June 14, 2018 · 8:19 a.m. · 10m 06s
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good morning ladies and gentleman first of all i'd like to send me show for the invitation it's a pleasure for me
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to have the possibility to speak today my task is to speak about the evidence is in hand factual management
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oh toast i've you speak about the eighty in general than about the existing evidence is
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in the treatment of factors after i would like to precise the actual trends in
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clinical research info on hand factor treatment after uh uh the we'll have
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some ideas about the potential future
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a. b. m.
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the main topic of our congress last year was the evidence base medici
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the um the the definition iteration of the best to search every dance
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this clinical expertise and patients that use the question is which is the most important among them
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we have to know that adrian itself became an independent science there's
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lot of studies dealing with the analysis of the b.
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the a. b. m.
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has beneficial effect when it but that a negative effect as well for
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example it can delete the basic knowledge and accumulated clinical experiences
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and then it in addition the main the most important thing in
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my opinion it doesn't provide useful guidance in a specific case
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what are the existing evidence is enhanced lectures to to to the basic principles are based on experiences
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that were accumulated over centuries the biological and mechanical knowledge of
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bone healing is the key point of the teacher
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the hand as you have heard before as a complex skeleton was long and short balls there's different
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by mechanical and healing properties that a large number
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of fracture variations and treatment options as well
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the introduction of you implants and surgical methods are not
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strictly regulated compared with the introduction of new trucks
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and plus the high level of scientific evidence is on hand factual management is to
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here we can see the relation between the level of evidence
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and the strengths of its recommendation the higher is the
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level of the evidence the stronger is the recommendation in this review
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the scientific
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everyone says the evening uh with the hand fracture treatment verdict for the uh were examined
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nine hundred ninety three or the general publications for evaluated and the results showed
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that there is a continuous increase in the evidence level of articles
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but the high level of evidence work is still on come
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no no more than a twelve percent
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using the treatment of fractures decision making process is needed
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the fancy factors of this process can be seen here are the main factor is a personal knowledge
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and which is based or studies and track to says the question
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is how the other factors influence our knowledge and decision
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we do not have to on this underestimate the role of the so called opinion leaders
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do you know the sentence on the bottom also is preferred method can it be considered as an evidence
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that would be the flowchart of the best treatment but the question is if
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it is possible to be up to date in latest clinical evidence is
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at least the guidelines and protocols should be revised according to the evidence is
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when you are treating a fracture we have to make yourself ourself decision making
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questions these questions are very simple but a simple questions to the side
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should we choose operative of conservative treatment after we choose an we
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have we have uh the possibility to choose between different implants
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we have to decide if you are have to use a bone graft
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or not if yes should it be that's whereas or non
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vascular as one graph and last but looking but not least the
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question of cost benefit it is very important in my opinion
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yeah
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if you're looking for special problem
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to find the solution to the problem of what uh other
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things which determines our diesel which the anatomical vocalisation
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the object of the study and the level of the study are
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very important these things give the practical effectiveness of a study
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here uh you can see the results of for research i may
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there is uh john cochran database in five years period
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we found twenty six articles dealing with hand factual statement in this they will be concluded the results
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it is not surprising that most of the the studies that these carpet bowls
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not the carpet looked at the car troubles but only with this cave it but which is interesting that are that the relative
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high number of studies dealing with the face the but the cup
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on that fractures or we know these type of fractures
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can there be healed without any treatment class which is
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was very important there there's no cost benefit studies
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we all know that many times in congress is in
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presentations uh a very often we are hitting about
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uh the the cost benefit of uh some intervention but i'm afraid we don't any of you guys
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these are the recommendations the results
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the distribution of them you got been conservative statement conservative
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or just operative treatment comparison of operative mess
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that's going grass was colours are there's is no that's where i was going to have
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and we found five basic by mechanical results as well
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here you can see the recommendations of the conservative treatments i i do not want to go through step
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by step on these recommendations those were interested in the are they can be found in the book
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here the recommendations of conservative versus operative treatment
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the recommendations of the operative treatment
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the question of numbers colour not versus vascular grafts and finally the biochemical results
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these are the findings i found interesting regarding conservative to come and
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there's a tendency towards limited fixations and mortal belies age
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conservative there's operative pigment there's no all time benefit of operative t. and
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the management of known displays factors even in this case wade
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mon displays the structures less colour graphs doesn't appear to be
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better against nebraska i guess for the treatment just gave
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it manually is the feast letter capital next fractures take meant
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to simple as we as i have mentioned but
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the entity it into the into mother eric dividing seems to be
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the best in terms of function and s. d. tickle
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aspects which was for me the most interesting a categorical model i study
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of the stability of different uh a fixation methods in this model
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of of some of phonics anaconda fractures in a flexion extension active range of a motion model
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they're found no difference regarding stability i mean one
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key among one key wire to key virus
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headless crews and black screws it's completely different uh is the is
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the facts they have learned in a new courses for example
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and finally i did a little bit provocative
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uh should we think about the future what are the possible ways
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to start basically how these high level of evidence is
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doesn't give as i have mentioned a special uh advice is in a special case they
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gave i think uh continues feedback of hard work that's why they are very important
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we can imagine that in the future we could use the active feature f. t. v.
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show intelligence to penalise all the data belongs to an individual that can lead
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do an engine driving personalise met c. but now that is
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the role of the so called experience search on
Conference Program
A-1205 Welcome and Introduction
June 14, 2018 · 8 a.m.
A-1206 Epidemiology
Kevin Chung, USA
June 14, 2018 · 8:04 a.m.
A-1206 Epidemiology Q&A
Kevin Chung, USA
June 14, 2018 · 8:16 a.m.
A-1207 Evidence
Janos Rupnik, Hungary
June 14, 2018 · 8:19 a.m.
A-1208 Conservative
Grey Giddins , UK
June 14, 2018 · 8:31 a.m.
142 views
A-1209 K-wire & cerclage
Anuj Mishra, UK
June 14, 2018 · 8:57 a.m.
119 views
A-1209 K-wire & cerclage - Q&A
Anuj Mishra, UK
June 14, 2018 · 9:08 a.m.
A-1210 Intramedullary screws
Maurizio Calcagni, Switzerland
June 14, 2018 · 9:15 a.m.
156 views
A-1210 Intramedullary screws - Q&A
Maurizio Calcagni, Switzerland
June 14, 2018 · 9:24 a.m.
A-1211 Plates & screws
Philippe Cuenod, Switzerland
June 14, 2018 · 9:29 a.m.
154 views
A-1211 Plates & screws - Q&A
Philippe Cuenod, Switzerland
June 14, 2018 · 9:42 a.m.
A-1212 External fixation
Frédéric Schuind, Belgium
June 14, 2018 · 9:45 a.m.
126 views
A-1213 Compound fractures
Thomas Giesen, Switzerland
June 14, 2018 · 9:54 a.m.
364 views
A-1213 Compound fractures - Q&A
Thomas Giesen, Switzerland
June 14, 2018 · 10:08 a.m.
238 views