Developing and evaluating evidence-based medicine in pediatric orthopaedic surgery

The purpose of this thesis was to review how a simple clinical pediatric orthopaedic surgeon might be able to create and use different levels of Evidence Based Medicine. Practicing evidence-based medicine involves the assessment of current available literature for its level of evidence, validity, and significance; and subsequently applying results to clinical practice. Much of the literature in pediatric orthopaedic surgery is level IV (case series) or level V (case reports). Despite the lower level, this literature is still important for reporting adverse events and disseminating information of novel treatment techniques. A case report of a novel adverse event is presented: permanent physeal arrest from the use of eight plate for guided growth. Following, a case series aimed to assess if the Fitbone intramedullary lengthening nail could provide successful lengthening with improved rehabilitation and minimal hospital stay, while achieving therapeutic aims of lengthening and correcting mechanical axis. Thirdly, one year of publications in 3 highly respected pediatric orthopaedic journals was reviewed. The use of “numbers needed to treat” as an adjunct to statistical analysis and level of evidence was determined for each article. And finally, a systematic review of the literature looks at the incidence of venous thromboembolism in pediatric orthopaedics. This study began with a stringent, comprehensive protocol that detailed the plan and search strategy. Initially, a meta-analysis was planned, but due to the level of evidence of the articles included, only descriptive statistics could be used. The many setbacks and delays demonstrated the difficulties in producing literature. A case study, case series, review of use of the statistical analysis Number Needed to Treat, and finally, a systematic review were produced