title: The influence of large clinical trials in orthopedic trauma: do they change practice?
abstract: OBJECTIVE
  To evaluate the influence of top fracture trials on the practice of orthopedic surgeons.
  
  
  METHODS
  This is a cross-sectional study.
  
  
  METHODS
  We electronically administered the survey to all members of the Canadian Orthopedic Association. We received responses for 222 surveys, of which, 178 surveys were completed.
  
  
  METHODS
  We distributed a survey that evaluated the influence of 7 important fracture studies (6 randomized controlled trials and 1 prospective cohort study) on practice, patient care and the overall advancement of knowledge in the field of orthopedics. This study was approved by our local ethics review board.
  
  
  METHODS
  The primary outcome measure was the perceived general influence and impact of important fracture studies on the perceptions and practice of orthopedic surgeons.
  
  
  RESULTS
  The Clavicular Fixation Trial (2007) and Tibial Fracture Trial (SPRINT, 2008) were perceived by surgeons to have the greatest influence on advancing overall knowledge in the field, improving personal practice, and the most influence on improving patient care. On the other hand, the Bone Stimulation in Fractures Trial (2011) and the recombinant human bone morphogenetic protein-2-BESST Trial (2002) had the lowest mean influence ranks. The probability of changing practice was significantly higher (Odds Ratio, 2.89; 95% confidence interval, 2.16-3.88; P < 0.00001) when studies had positive outcomes in comparison with negative outcomes.
  
  
  CONCLUSIONS
  Despite the complexity and costs associated with clinical trials in orthopedic trauma, the results from this survey suggest that these studies result in a demonstrable perceived influence and impact on the practice of orthopedic surgeons.
authors.affiliation: *McMaster University, Hamilton, Ontario, Canada; and †Division of Orthopedic Surgery, Department of Surgery, McMaster University, Hamilton, Ontario, Canada.
authors.forename: Hassan
authors.initials: H
authors.lastname: Khan
authors.forename: Nasir
authors.initials: N
authors.lastname: Hussain
authors.forename: Mohit
authors.initials: M
authors.lastname: Bhandari
mesh_terms: D002170:Canada / Q000453:epidemiology; D002986:Clinical Trials as Topic / Q000706:statistics & numerical data* / Q000639:trends; D003430:Cross-Sectional Studies; D019317:Evidence-Based Medicine / Q000706:statistics & numerical data / Q000639:trends; D050723:Fractures, Bone / Q000453:epidemiology / Q000628:therapy*; D019538:Health Care Surveys; D006801:Humans; D019637:Orthopedic Procedures / Q000706:statistics & numerical data* / Q000639:trends; D009985:Orthopedics / Q000706:statistics & numerical data* / Q000639:trends; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data* / Q000639:trends; D016896:Treatment Outcome