INTRODUCTION. Orthopaedic practice is not always aligned with new evidence which may result in an
evidence-practice gap. Our aim was to present and report the use of a new model for implementation of
evidence-based practice using treatment of distal radius fractures (DRF) as an example.
METHODS. A new implementation model from the Centre for Evidence-Based Orthopaedics (CEBO) was
applied. It comprises four phases: 1) baseline practice is held up against best available evidence, and barriers
to change are assessed. 2) A symposium involving all stakeholders discussing best evidence is held, and
agreement on a new local guideline is obtained. 3) The new guideline based on the decisions at the
symposium is prepared and implemented into daily clinical practice. 4) Changes in clinical practice are
recorded. We applied the model on the clinical question of whether to use open reduction and internal
fixation with a locked volar plate (VLP) or closed reduction and percutaneous pinning (CRPP) in adults with
DRF.
RESULTS. Prior to application of the CEBO model, only VLP was used in the department. Based on best
evidence, the symposium found that a change in practice was justified. A local guideline stating CRPP as first
surgical choice was implemented. If acceptable reduction could not be obtained, the procedure was
converted to VLP. A year after implementation of the guideline, the rate of VLP had declined from 100% to
44%.
CONCLUSION. It is feasible to change surgeons’ practice according to best evidence using the CEBO model.
FUNDING. None.
TRIAL REGISTRATION. Not relevant.