Hello Dear Ashok

I think IM nailing is now a new way but if it is compared with Plate technique it may have enough value to be published in the valuable scientific journals. First of all you should be able to save your cases. The next step is the design of your study. I think it would be valuable if you design three to four groups based on your injury model (Simple transverse fractures: Closed group). In the first group you should fix the fracture site with plate technique. In the second group you should fix the fracture site with IM Nailing. in the third group you may like to compare these two methods with external fixator techniques and in the last group you should be more novel. You may like to use the tissue engineered adhesive materials to fix the fracture site internally. Then after, you should design your criteria. For example the degree of satisfaction of your patients after the surgical operation is an important criterion. It is therefore important to follow your patients and score their degree of satisfaction. Another factor is the need for removing the fixator after the surgery. Perhaps the plates may be need to be removed more than IM Nailing. This factor should be followed for at least one year post surgery. Any complications should be noted. Any abnormality should be saved and the repair process at the fracture site should be radiographically followed. Perhaps the repair time is different between these techniques. You should be able to take many photographs from your patients to have enough evidence regarding different pattern of bone healing is occurred between your groups. An important step in scientific publication is the photographes. You should be able to show your evidences by several high quality figures. Your study should have a valuable aim, hypothesis, and also it should have valuable and well descriptive methodology following a good results presentation and description. The knowledge of scientific writing is important. If you find these information helpful then we can further discuss about this issue.

Dear Ali Moshiri,

Thank You very much for your suggestions.

I am a final year Resident doing my Residency in PR China as a foreign student. So, it is not possible for me to do a Prospective study. Since I, only have 1 year left and that is not sufficient duration for the Follow-up, particularly until the Implant removal. So, I have designed a Retrospective Study. If possible, I would like to compare "Plating Vs IM nailing Vs Conservative treatment methods". But, as I mentioned I don't know Why but Plating is very popular here. So, I may not find enough cases other than the Plating.

So, what if rather than a Comparative study I mention "The result of Plating in Closed, Simple, Transverse fracture of shaft of femur in an Adult" ???

Regards.

Dear Ashok

Your response was well oriented me about your situation. In this case I suggest you to compare the few cases of IM Nailing with many cases of plating and discuss this limitation in the end of your discussion in your new manuscript. I suggest you to present your research as a review of a literature and case series. The point is that why the plating technique is more popular than other technique. You should investigate this and also it is important to investigate the short to mid (eg. 6 month post operation) of plating technique. You can compare you case series of plating with few cases of IM Nailing but should be able to well clarify the advantages and disadvantages of each techniques and their outcomes. As suggested you can discuss about your limitations in the discussion but be careful to be conservative about your limitations which can guide the reviewers to reject your paper. One of the most important parts of the scientific article is belonged to the discussion. You should also compare your results with the results of other studies. For example you may find a study which used IM nailing alone or compared with plating. These types of studies is beneficial for your work. By these suggestions you can publish a good work but please remember that you should be able to provide some beneficial and scientific evidences about some important concepts especially fracture healing. You can follow your current cases for the healing quality of the fracture site by radiography. To have a successful work, I suggest you to combine your retrospective study with prospective results. In this case you should search the previous results in your hospital and compared them with the current and future investigations with the same methods in the same hospital. This together with the above suggestions will possibly greatly increase the impact of your study and satisfy the editorial boards and the reviewers to publish your work.

. Dear Ali,

It's a pleasure to receive such an innovative suggestion.

Always looking forward to hear from you.

Thanking you.

With Regards

Please accept my best wishes and good luck in your scientific work

Yours Sincerely

Ali

Dear Ashok

In Brasil the plate fixation in the femoral shaft fractures is very popular in some regions (socio economic situation). The principal disadvantage of plate fixation in a simple fracture is the soft tissue lesions because you need direct reduction and absolute stability (strain theory) In a doctoral thesis in the University of Campinas - Brasil an orthopedic surgeon used a long wave plate (DCP 4,5mm) . with 3 screws in each side, without bone graft and all fractures united (AO32A). The procedure was indirect reduction and relative stability. The wave decreased the stress in the middle of the plate and the consolidation was secondary in spite of simple fracture. Why not :The result of Wave Plating in Closed, Simple, Transverse fracture of shaft of femur in an Adult - Prospective study in your country ?

Dear Nelson,

I heartily appreciate your suggestion.

I agree that socioeconomic could be a factor for the use of Plating.

During my short 2 years experience as a medical officer in the department of orthopedics surgery back in my country before my Residency, I experienced that for AO32A fracture in adult, we opted IM nailing as the treatment of choice. So, it would be difficult to perform a Prospective study of “The result of Wave Plating in Closed, Simple, Transverse fracture of Shaft of femur in Adult”. Use of Plating in Adult is uncommon. Since I can get as many cases here, I thought of doing the Research during my 1 year stay, here in China.

Thank You.

Ok

Best regards

Thank you.

I think you are complicating your academic life unnecessarily!! Do not aim for innovative research; that will come with time. Read current literature that interest you most. In every publication there is a suggestion about what future research is needed in that particular subject / topic. By caring out or doing that research, your paper stands a good chance of publication because it is adding to the ONGOING discussion. In this way you will avoid re-discovering the wheel or worse still, a flat tyre.