Timing in orthopaedic surgery - Rethinking traditional myths with a critical perspective.

Area of Science:

• Orthopaedic Surgery
• Evidence-Based Medicine
• Surgical Timing

Background:

• Standard operating procedures in orthopaedics often rely on tradition rather than evidence.
• Temporal guidelines for surgical urgency require critical evaluation in the context of evidence-based medicine.

Purpose of the Study:

• To review and analyze critical temporal guidelines in orthopaedic surgery.
• To assess the practical relevance and potential need for optimization of surgical timing.

Main Methods:

• Systematic literature review using PubMed.
• Searched for evidence on time to surgery for proximal femoral fractures, femoral neck fractures, proximal humeral fractures, ligament/tendon injuries, spinal cord injuries, open fractures, and fracture-related infections.

Main Results:

• Strong evidence supports treatment within 24 hours for proximal femur fractures and spinal cord injury decompression.
• Limited reliable evidence exists for the 6-hour rule in open fractures, femoral neck fractures, ligament injuries, humeral head fractures, and fracture-related infections.

Conclusions:

• Resource-adapted surgical planning is advisable based on current evidence.
• Further research is essential to establish optimal treatment timing for various orthopaedic conditions.