Change in orthopaedic surgeon behaviour by implementing evidence-based practice.

Area of Science:

• Orthopaedic Surgery
• Evidence-Based Medicine
• Healthcare Implementation Science

Background:

• Orthopaedic practice often lags behind new evidence, creating an evidence-practice gap.
• Implementing evidence-based practice in surgery requires structured models.
• Distal radius fractures (DRF) serve as a relevant clinical example for evaluating implementation models.

Purpose of the Study:

• To present and evaluate a novel implementation model for evidence-based practice in orthopaedics.
• To assess the effectiveness of the Centre for Evidence-Based Orthopaedics (CEBO) model in changing surgical practice.
• To address the evidence-practice gap in the surgical treatment of distal radius fractures.

Main Methods:

• The CEBO model, comprising four phases (assessment, symposium, guideline implementation, outcome recording), was applied.
• The model was specifically used to evaluate the treatment of distal radius fractures (DRF).
• The clinical question focused on comparing open reduction internal fixation with a locked volar plate (VLP) versus closed reduction percutaneous pinning (CRPP).

Main Results:

• Baseline practice exclusively used VLP for DRF treatment.
• Following the CEBO model implementation, a new guideline favored CRPP as the primary surgical choice.
• One year post-implementation, the utilization of VLP for DRF decreased from 100% to 44%.

Conclusions:

• The CEBO model is a feasible and effective tool for changing surgeons' practice based on best available evidence.
• Successful implementation led to a significant shift in surgical technique for distal radius fractures.
• This study demonstrates the potential of structured implementation models to bridge the evidence-practice gap in orthopaedics.