I read with interest Dr. Cameron's letter about tibial plateau fractures (Can J Surg 2004;47:149). This is the second time he has written on this subject, with the same conclusion that “tibial plateau fractures seldom progress to total knee replacement unless there are surgical complications.”
Although Dr. Cameron refers to a large caseload (3000 cases), I am concerned that there may be a bias. Does Dr. Cameron treat tibial plateau fractures? Has he followed the results of those fractures to see how many have come to a joint replacement? If there are other surgeons in his institution who treat tibial plateau fractures, what are their results for subsequent incidence of total knee replacement? Were his patients carefully and prospectively asked if they had ever sustained knee trauma?
If Dr. Cameron does not treat tibial plateau fractures, is it possible that those patients with poor results have their joint replacements performed by the surgeons that treated the original presenting fracture?
It seems that this letter represents informal conclusions from an uncontrolled cohort without the benefit of peer review. Can it be misleading? Is it appropriate to publish?
Bernhard E. Driedger, BScMed, MD Consulting Orthopedic Surgeon Cranbrook, BC