Investigation on the level of evidence in researches done by orthopedic residents of the Department of Orthopedics, Philippine General Hospital over the past twenty-seven years

BACKGROUND: Clinical research has been part of the orthopedic residents' training program over the past 27 years of the Department of Orthopedics, Philippine General Hospital. The purpose of the present study was to determine the levels of evidence in the researches done by orthopedic residents in training from January 1983 to December 2010. METHODS: The authors reviewed all completed research performed by the department's orthopedic residents in training from January 1983 to December 31, 2010. The exclusion criteria for the study were as follows: review articles, research articles whose full texts were not available and those research articles in which consultants were primary authors. The research articles were scored according to the level of evidence proposed by the Journal of Bone and Joint Surgery (American Volume), and were categorized according to decade: 1980s, 1990s, and 2000s.  RESULTS: A total of 24 research articles were retrieved and reviewed. There were no Level I studies performed in the department by the residents since 1983. There was a significant increase in the number of Level II and Level III studies from the 1980s to the 2000s (p=0.0001). The Hand Section had the highest number of Level II studies 8.6% (3 out of 35) while the Adult Section had the highest number of Level III studies at 21% (11 out of 53). The Pediatric Section had the highest number of Level IV studies at 91% (30 out of 33). CONCLUSION: The level of evidence in research conducted by the orthopedic residents in training of the Department of Orthopedics, Philippine General Hospital has improved significantly in the past 27 years.

Osteosarcoma in the preadolescent Filipino patient

Objective. Classic high-grade osteosarcoma is uncommon in preadolescents (less than or equal to 10 years of age). The possibilities of clinicopathologic differences from the typical adolescent osteosarcoma patient have been raised. We sought to compare the presentation, treatment and survival of this subgroup of patients with published rates in order to determine if there is a need to use a treatment regimen different from that for regular adolescent osteosarcoma patients. Methods. Records of the University of the Philippines-Musculoskeletal Tumor Unit (UP-MuST) over a 15-year period (1993-2008) were reviewed and data collected on patients 10 years and younger with biopsy-proven classic high-grade intramedullary osteosarcoma who underwent complete treatment by the Unit. Demographics and survival rates were then compared with published rates for preadolescent and regular adolescent osteosarcoma cases. Results. There were fourteen patients; (6M:8F; age: 4-10 years). The most common presentation was a painful mass in the distal femur (8); the tumors most commonly had osteoblastic histology (12). Treatment consisted of neoadjuvant chemotherapy, wide surgical excision through ablation (9) or limb-saving surgery (5), and postoperative chemotherapy. There was a good histologic response (over 90% tumor necrosis) in four patients. Seven patients are ANED (alive no evidence of disease) 25 to 186 months after diagnosis. Five-year survival estimate is 52%, compared to a dismal 5 to 10% 15 years ago. Conclusion. Clinicopathologic presentation, clinical course, and overall survival in this subgroup of patients are comparable with published results for both preadolescent and adolescent osteosarcoma patients. There is no need to alter the present treatment regimen for this group of young patients.