Comparative study of single lateral locked plating versus double plating in type C bicondylar tibial plateau fractures.

Sir,

We read with interest the article entitled, “Comparative study of single lateral locked plating versus double plating in type C bicondylar tibial plateau fractures” published in Indian J Orthop (2015;49:193–8).1 We appreciate the effort taken by the authors for conducting this study. However, we have a basic concern with the conclusion drawn by the authors on the basis of this study. The authors conclude that double plating through two incisions resulted in a better limb alignment and joint reduction with an acceptable soft tissue complication rate. The study being a surgeon-specific cohort study may not be able to conclude this adequately. The two groups identified such as SP operated by one group of surgeons and DP operated by another group. The only criteria adopted for some sort of matching between these two groups were that all surgeons who participated in the study had at least 3 years of experience post residency. This may not be adequate and other parameters should have been taken into account while conducting this study.

This study draws its conclusions from a database that is purely observational in nature, and this is a major concern. This concern needs to be addressed before formulating conclusions. Conclusions such as the one as arrived at by the authors needed a better study design such as the randomized controlled trial (RCT). We do understand the limitations of conducting an RCT in surgical research. It is known fact that surgical treatments are half as likely as medical therapies based on RCT evidence and difficulty in RCTs may reflect ethical challenges to randomization.2 As a result, most surgical research uses retrospective designs, often with a small number of patients.2 Despite the efforts to design a methodologically sound surgical technique study and perform proper statistical analyses, the results may not accurately reflect the true situation. This is a major concern in observational studies of surgical interventions.

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Conflicts of interest

There are no conflict of interest.