When observational studies are as helpful as randomized trials: examples from orthopaedic trauma

Randomized controlled trials (RCTs) are often challenging to design in surgical fields and can be misleading when poorly executed. While the prevailing belief is that observational studies on therapeutic efficacy are credible only in exceptional circumstances due to unrecognized confounding, we identify three types of intervention in orthopaedic trauma and illustrate relevant features that allow observational studies in orthopaedic surgery to be as helpful as RCTs.