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Excerpt
We appreciate the comments by Dr. Starr. It must be remembered that in a retrospective review all is not perfect, and the data collected must be considered in that light. Outlined below are the answers to his questions.
We stand by our conclusion to consider early fracture stabilization of FRIs in polytrauma children with MISS >40 and age >7 years. This is not a dogmatic recommendation. The timing of osteosynthesis as a predictor of a COI denoted a p value of 0.097; we find it ethically difficult to undertake a scientifically pure double-blind prospective study to further investigate this question with this p value. As previously stated, medicine is not just a science but also an art. Therefore the clinician should consider osteosynthesis not dogmatically recommend it. It is here that the true nature of a physician is seen: consider all variables, both objective and subjective, and come to a treatment plan acceptable to both the physician and parents of the injured child.
The authors thank Dr. Starr for his insightful comments.
