# Management preferences of orthopedic surgeons in rickets patients in Turkey: Results of a nationwide survey

## TL;DR

This study explores how Turkish orthopedic surgeons manage rickets patients, finding that experience and access to pediatric endocrinologists influence treatment and referral decisions.

## Contribution

The study provides insights into orthopedic surgeons' management preferences for rickets in Turkey and identifies factors affecting diagnostic and referral practices.

## Key findings

- Experienced surgeons are less likely to refer rickets patients to pediatric endocrinologists.
- Surgeons with limited pediatric patient exposure are more likely to refer without testing or treatment.
- Access to pediatric endocrinologists increases referral rates without preliminary steps.

## Abstract

Rickets remains a significant health issue, particularly in developing countries. This study evaluated the management preferences of orthopedic surgeons in Turkey regarding rickets and analyzed these approaches from a pediatric endocrinology perspective.

An online survey was developed based on a comprehensive literature review and previous similar studies. The survey link was distributed via email to members of the Turkish Orthopedic and Traumatology Association and the Pediatric Orthopedics Association. The questionnaire included 14 multiple-choice items addressing sociodemographic characteristics and the general approach to the diagnosis and treatment of rickets. Prior to dissemination, the survey was reviewed by 13 board-certified orthopedic surgeons from various institutions to ensure clarity and content validity.

Of the 257 respondents, 198 met the inclusion criteria and were included in the analysis. Orthopedic surgeons with more than 10 years of experience (n = 111,56.1%) were significantly less likely to refer rickets patients to a pediatric endocrinologist (p = 0.009) and more likely to recommend oral or intramuscular 25-OH-vitamin D3 ampoule treatment rather than oral drops or capsules (p < 0.001). Surgeons who saw fewer than 25% pediatric patients in daily practice (n = 110,55.6%) were more inclined to refer patients without ordering diagnostic tests or initiating treatment (p = 0.011). The presence of a pediatric endocrinologist within the same institution (n = 96,48.5%) was also associated with increased referral rates without preliminary testing or treatment (p = 0.003/p = 0.002, respectively). Physicians who encountered at least one rickets patient per week (n = 78,39.4%) demonstrated better knowledge of normal serum 25-OH-vitamin D3 levels (p = 0.042) and were significantly less likely to refer patients to a pediatric endocrinologist (p < 0.001).

Management approaches to rickets among orthopedic and traumatology specialists in Turkey vary significantly depending on clinical experience, practice setting, and access to a pediatric endocrinologist. To prevent both undertreatment and unnecessary referrals, newly diagnosed rickets patients in orthopedic clinics should be appropriately evaluated and referred when necessary. Establishing a standardized diagnostic and referral algorithm based on international guidelines and incorporating it into orthopedic training programs is strongly recommended.