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Injury
journal homepage: www.elsevier.com/locate/injury
Letter to the Editor
Letter regarding “Open reduction and internal fixation alone
versus open reduction and internal fixation plus total hip
arthroplasty for displaced acetabular fractures in patients older
than 60 years: A prospective clinical trial”
Dear editor
We read the article by Manson et al. with great interest, and
we appreciate the authors’ great efforts to clarify the best treat-
ment for acetabular fractures in older patients, for which no con-
sensus has been reached thus far [1]. However, we would like to
suggest three suggestions that might influence the interpretation
of this article.
First, not all items set in the protocol were reported, and the
timing of measurement was inconsistent with the protocol [2].
Only two of the 10 primary outcomes specified in the protocol
were selectively reported. In terms of timing, a significant differ-
ence was reported in the reoperation rate at 2 years. However, the
primary outcome measurement was set at 1 year in the protocol.
In a systematic review (SR) and meta-analysis, the median time to
total hip arthroplasty (THA) after acetabular fracture was 37 (27–
74) months [3]. The authors might have chosen the 2-year outcome
as the 1-year reoperation rate might not have shown a significant
difference. This may be considered a spin because the results are
based on selective reporting and are emphasized in the results and
abstract [4]. If this result is to be reported, it would have been bet-
ter to report the results as per the protocol at 1 year and the re-
sults at 2 years as additional analysis.
In addition, their result concluding that there was a significant
reduction in reoperation is fragile. The fragility index indicates how
many participants would be required to convert a study from be-
ing statistically significant to not significant [5]. The index for out-
comes was 2. It is considered less robust when the number of pa-
tients lost to follow-up is greater than the index value. Therefore,
considering their loss to follow-up in the THA group (n = 3), the
significant result in the reoperation rate is less robust.
Finally, because the authors mixed samples from the random-
ized controlled trial (RCT) and the observational study, the data in
Tables 2 and 3 cannot be used for meta-analysis and SR. To use
the data in this paper in a future SR of RCTs, we would like to ask
the authors to present the data from the RCT and the observational
study separately in Table 2 and Table 3.
Once again, we thank the authors for providing novel and valu-
able data and analysis findings. However, as discussed above, we
think that their statistically significant result should be interpreted
with caution because this is not a pre-specified outcome and less
robust. In addition, the data from the RCT and observational study
should be reported separately for future SR. We believe that these
three suggestions will make future clinical research more valuable.
https://doi.org/10.1016/j.injury.2021.11.056
0020-1383/© 2021 Elsevier Ltd. All rights reserved.
[m5G;January 9, 2022;9:5]
Declaration of Competing Interest
None.
Acknowledgment
The authors would like to thank Editage (www.editage.jp) for
the English language review.
Reference
[1] Manson TT, Slobogean GP, Nascone JW, Sciadini MF, LeBrun CT, Boulton CL.
Open reduction and internal fixation alone versus open reduction and internal
fixation plus total hip arthroplasty for displaced acetabular fractures in patients
older than 60 years: a prospective clinical trial. Injury 2021 in press, available
online 2 Oct, 202110.1016/j.injury.2021.09.048.
[2] ClinicalTrials.gov [Internet]. Bethesda (MD): National Library of Medicine(US).
20 0 0 Feb 29 -. Identifier NCT03419182,RCT Determining Best Treatment for
Geriatric Acetabular Fractures (GeriTab); 2017 September 22 [cited 2021 October
15]. Available from https://www.clinicaltrials.gov/ct2/show/NCT03419182?term=
NCT03419182&draw=2&rank=1
[3] Stibolt RD, Patel HA, Huntley SR, Lehtonen EJ, Shah AB, Naranje SM. Total
hip arthroplasty for posttraumatic osteoarthritis following acetabular fracture: a
systematic review of characteristics, outcomes, and complications. Chin J Trau-
matol - English editor 2018;21:176–81 10.1016/j.cjtee.2018.02.004.
[4] Boutron I, Dutton S, Ravaud P, Altman DG. Reporting and interpretation of ran-
domized controlled trials with statistically nonsignificant results for primary
outcomes. JAMA - J Am Med Assoc 2010;303:2058–64 10.1001/jama.2010.651.
[5] Walsh M, Srinathan SK, McAuley DF, Mrkobrada M, Levine O, Ribic C,
et al. The statistical significance of randomized controlled trial results is fre-
quently fragile: a case for a Fragility Index. J Clin Epidemiol 2014;67:622–8
10.1016/j.jclinepi.2013.10.019.
Shiho Oide
Department of Obstetrics and Gynecology, Kitasato University
Medical Center, Arai 6-100, Kitamoto-shi, Saitama 364-8501, Japan
Scientifics Research WorkS Peer Support Group (SRWS-PSG),
Osaka, Japan
Masahiro Banno
Scientifics Research WorkS Peer Support Group (SRWS-PSG),
Osaka, Japan
Department of Psychiatry, Seichiryo Hospital, Tsurumai 4-16-27,
Showa-ku, Nagoya 466-0064, Japan
Department of Psychiatry, Nagoya University Graduate School of
Medicine, Tsurumai-cho 65, Showa-ku, Nagoya 466-8560 Japan
Akihiro Saitsu
Scientifics Research WorkS Peer Support Group (SRWS-PSG),
Osaka, Japan
Department of General Medicine, Taragi Municipal Hospital, 4210
Taragi, Taragi-machi, Kuma-gun, Kumamoto 868-0598, Japan
Natsumi Saka∗
Scientifics Research WorkS Peer Support Group (SRWS-PSG),
Osaka, Japan
JID: JINJ
ARTICLE IN PRESS [m5G;January 9, 2022;9:5]

S. Oide, M. Banno, A. Saitsu et al. Injury xxx (xxxx) xxx

Department of Health Research Methods, Evidence & Impact,

McMaster University, 1280 Main Street West, Hamilton, Ontario, L8S
4K1, Canada
Department of Orthopaedics, Teikyo University School of Medicine,
1-2-11 Kaga, Itabashi-ku, Tokyo 174-0054, Japan
∗ Corresponding
author at: Department of Health Research
Methods, Evidence & Impact, McMaster University, 1280 Main
Street West, Hamilton, Ontario, L8S 4K1, Canada.
E-mail addresses: shihooide@gmail.com (S. Oide),
solvency@med.nagoya-u.ac.jp (M. Banno), m07039as@jichi.ac.jp (A.
Saitsu), natsumi613@gmail.com (N. Saka)