rev bras ortop.2016;51(5):487–488
SOCIEDADE BRASILEIRA DE ORTOPEDIA E TRAUMATOLOGIA
w w w . r b o . o r g . b r
Editorial
RBO
with
no
consensus
RBO
sem
consenso
Havingasingleconductforthetreatmentofpathologiesin ourareahasalwaysbeenadreamofsomeauthorsandheads ofservice,whichhasfortunatelyneverbeenreached.
Wehavesomeexamplesofconductforthetreatmentof certainpathologies,whichduetotheclarityofexpositionand reliabilityoftheauthors,persistedforyearsanddelayedthe developmentoftheirstudy.
The shoulder pathology was restricted to periarthritis andtreatment byinfiltrationsforyears untilNeer,in1982, developedtheimpacttheoryandexplainedthe mechanical-degenerativejointprocess;thegeniusofprof.HenryDejour delayedfordecades thedevelopmentofthepatellofemoral diseasestudy,disregardinginhisremarkablealacartemenu for the treatment of patellofemoral instability, the medial patellofemoralligament.Hundredsoforthopedistsdelighted withtheclarityoftheFrenchmaster’sideastreatedthe insta-bilityofthepatellofemoraljointwithoutconsideringthejoint ligaments.
The treatment of a tibial fracture is a conservative one, exceptwhen there is fibular integrity, as declared by Sarmiento;wecannotevencommentonthisstatementtoday. Therewasaperiodwhenevidence-basedMedicinebecame verypopular,whichgavegreatimpetustometa-analysesto thepointofmakingthemlevel1forscientificpublications.
Thismeans that a double-blindrandomizedstudy with adequatefollow-up,carriedoutbyagroupofsurgeonsand clinicians involved with patients and responsible for the assessedtherapeuticoptionandwhoanalyzedtheresultof this option, has the same valueas a study carried out by bureaucratsinaroom,whoselectedandanalyzedpublished studies onasubject withwhich theyhad no involvement. Thesestudiesproducesuchevidence,onwhichourconducts shouldbebased.
Onceagain,fortunatelytimeandpracticehaveshownthat Medicineshouldbebasedonexperience.
Anewattempttosimplifythecomplextherapeuticactivity nowappearsintheso-calledconsensusesthatsome institu-tionshavesuggested.Wehavesomecurrentexamples:
- Moseley JB published in 2002 a study at the prestigious NewEnglandJournalofMedicine,inwhichheperformed arthroscopiesinsomepatientsandpretendedtoperform themin others,whowere patients withosteoarthritisof theknee,anddeclaredthatperformingornotarthroscopic treatment in the knee with arthrosis yielded the same result.
Fewareasinorthopedicshavesomanyvariablesas arthro-sis;suchastatementisabsurdandunfounded,butdelighted theworldoflimitedindividualsandtookseveralcolleaguesto thecourtsduetosuitsbasedonthatwork.
- Totreatornottotreatsurgically afracture ofthe calca-neusleadstothesameresults.Thisisastatementpublished intheBritishMedicalJournalandsuggeststhatoneofthe majoradvancesinthetreatmentofseverecalcaneal frac-turesbediscontinued.
- Vertebroplasty isstronglycontraindicated. Thisisoneof theconsensusesoftheAmericanAcademyofOrthopaedic Surgeons(AAOS)forthetreatment ofosteoporoticspinal fractures.
Recentstudieshaveshownthatthisconceptiswrong,as wellasthosesuggestedconsensuses.Iimaginethatthereare severalothersandthatseveral“heads”definedefinitive dog-masaboutseveralconducts.
Ourknowledgeisbuiltinsteps.Forthisreasonweinsiston publishing,inadditiontofullpapers,casereportsand tech-nicalnotes,astheymaystimulateresearchandexchangeof experiencesthatwillconstructthisdifficultbuildingof med-icalknowledgeinthetherapeuticarea.
488
rev bras ortop.2016;51(5):487–488Thediscoveryofpenicillin,whichchangedthehistoryof Medicine,wasmadebyAlexanderFleming.Heobservedthat culturesinfectedwithPenicillium,agenusoffungithatcreates breadmolddidnotallowthegrowthofbacteriainthatculture medium.
Thesewereobservationsthatwouldnotfitthestrict pub-licationstandardsimposedbysomescientificjournals,notto mentionthefeetheychargeustopublish.Surelythesetwo importantcommunicationswouldnotbepublishedinthese journals.
Althoughseveraleditorshavesuggestedtheendofthe pub-licationofcasereportsandtechnicalnotesinthejournals,RBO
willcontinuetobeajournalwithoutaconsensus,publishing everythingthatisreliable,withoutpreviousrestrictions.
GilbertoLuisCamanho RevistaBrasileiradeOrtopedia,Brazil E-mail:[email protected]
2255-4971/©2016PublishedbyElsevierEditoraLtda.on behalfofSociedadeBrasileiradeOrtopediaeTraumatologia. ThisisanopenaccessarticleundertheCCBY-NC-NDlicense (http://creativecommons.org/licenses/by-nc-nd/4.0/).
