Natural experiments in thoracic and upper extremity trauma research

The overall aim of this thesis is to explore the value of natural experiments in
orthopaedic trauma surgery.
This is focused on thoracic and upper extremity injuries where, due to a lack of high
quality evidence, there is a lot of practice variation, between national hospitals, and
between countries such as the Netherlands and Switzerland.
This thesis extends three parts. In the first part we will dive into thoracic trauma and
affiliated fractures. We start with a clinical lesson in the assessment of rib fractures
(Chapter 2). Then we investigate what the current evidence is on optimal treatment
of rib fractures in elderly patients (Chapter 3). Chapter 4 is the primary study of this
part as it is the first prospective natural experiment of this thesis which compares
operative treatment to nonoperative treatment in patients with multiple rib fractures.
We conclude part 1 with complementary studies which focuses solely on nonoperative
treatment and outcomes (Chapter 5), the quality of life after rib fixation (Chapter 6)
and then what the effect of rib fixation is on patients with affiliated clavicle fractures
(Chapter 7) and scapula fractures (Chapter 8).
In the second part we add an extra layer to the methodology and introduce the
expert panel process to further reduce confounding. In Chapter 9 we discuss the
research proposal of the natural experiment and in Chapter 10 we present the
results of the second prospective natural experiment study of this thesis which
compares operative treatment to nonoperative treatment in patients with proximal
humerus fractures
Part 3 solely consist of Chapter 11 where we discuss the Dutch trauma registry, which
could be a potential basis for more data driven natural experiment trauma studies.