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Challenges and barriers to improving care of the musculoskeletal patient of the future - a debate article and global perspective

Hangama C Fayaz1*, Jesse B Jupiter1, Hans Christoph Pape2, R Malcolm Smith1, Peter V Giannoudis3, Christopher G Moran4, Christian Krettek5, Karl J Prommersberger6, Michael J Raschke7 and Javad Parvizi8

Author Affiliations

1 Department of Orthopaedic Surgery, Harvard Medical School, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114, USA

2 Department of Orthopaedic Trauma, University of Aachen Medical Center, Pauwelsstraße 30, 52074 Aachen, Germany

3 Department of Trauma and Orthopaedic Surgery, School of Medicine, University of Leeds, Leeds LS2 9JT, UK

4 Department of Orthopaedic Trauma, University Hospital, Queen's Medical Centre, GB-Nottingham, NG7 2UH, UK

5 Department of Trauma Surgery, Hannover Medical School, Carl-Neuberg-Str. 1, 30625 Hannover, Germany

6 Clinic for Special Hand Surgery, Salzburger Leite 1, 97616 Bad Neustadt an der Saale, Germany

7 Department of Trauma Surgery, University Hospital Muenster, Albert-Schweitzer-Campus 1, 48149 Münster, Germany

8 Rothman Institute of Orthopedics Philadelphia, Thomas Jefferson University Hospital, 925 Chestnut Street, 5th Floor, Philadelphia, PA 19107, USA

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Patient Safety in Surgery 2011, 5:23  doi:10.1186/1754-9493-5-23

Published: 25 September 2011



With greater technological developments in the care of musculoskeletal patients, we are entering an era of rapid change in our understanding of the pathophysiology of traumatic injury; assessment and treatment of polytrauma and related disorders; and treatment outcomes. In developed countries, it is very likely that we will have algorithms for the approach to many musculoskeletal disorders as we strive for the best approach with which to evaluate treatment success. This debate article is founded on predictions of future health care needs that are solely based on the subjective inputs and opinions of the world's leading orthopedic surgeons.

Hence, it functions more as a forum-based rather than a scientific-based presentation. This exposé was designed to stimulate debate about the emerging patients' needs in the future predicted by leading orthopedic surgeons that provide some hint as to the right direction for orthopedic care and outlines the important topics in this area.


The authors aim to provide a general overview of orthopedic care in a typical developed country setting. However, the regional diversity of the United States and every other industrialized nation should be considered as a cofactor that may vary to some extent from our vision of improved orthopedic and trauma care of the musculoskeletal patient on an interregional level.

In this forum, we will define the current and future barriers in developed countries related to musculoskeletal trauma, total joint arthroplasty, patient safety and injuries related to military conflicts, all problems that will only increase as populations age, become more mobile, and deal with political crisis.


It is very likely that the future will bring a more biological approach to fracture care with less invasive surgical procedures, flexible implants, and more rapid rehabilitation methods. This international consortium challenges the trauma and implants community to develop outcome registries that are managed through health care offices and to prepare effectively for the many future challenges that lie in store for those who treat musculoskeletal conditions.

Global perspective; Future trends and needs; Algorithms of patient care; Quality assurance in Patient care; Registries