Turhan Banu, Yaşar Niyazi Erdem, Sungur Mehmet Ali, Turhan Yalçın, Bekmez Şenol
Department of Pediatric Endocrinology, Ankara Atatürk Sanatoryum Education and Research Hospital, Ankara, Turkey.
Department of Orthopedics and Traumatology, Health Sciences University, Bilkent Children's Hospital, Ankara, Turkey.
PLoS One. 2025 Aug 7;20(8):e0329944. doi: 10.1371/journal.pone.0329944. eCollection 2025.
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.
佝偻病仍然是一个重大的健康问题，尤其是在发展中国家。本研究评估了土耳其骨科医生对佝偻病的管理偏好，并从儿科内分泌学角度分析了这些方法。
基于全面的文献综述和以往类似研究设计了一项在线调查。调查链接通过电子邮件分发给土耳其骨科与创伤外科学会和小儿骨科学会的成员。问卷包括14个多项选择题，涉及社会人口统计学特征以及佝偻病诊断和治疗的一般方法。在分发之前，来自不同机构的13名获得委员会认证的骨科医生对调查进行了审核，以确保清晰度和内容效度。
在257名受访者中，198名符合纳入标准并被纳入分析。经验超过10年的骨科医生（n = 111，56.1%）将佝偻病患者转诊至儿科内分泌科医生的可能性显著降低（p = 0.009），且更有可能推荐口服或肌肉注射25-羟基维生素D3安瓿治疗而非口服滴剂或胶囊（p < 0.001）。在日常实践中看诊儿科患者少于25%的外科医生（n = 110，55.6%）更倾向于在未进行诊断检查或开始治疗的情况下转诊患者（p = 0.011）。同一机构内有儿科内分泌科医生（n = 96，48.5%）也与在未进行初步检查或治疗的情况下转诊率增加相关（分别为p = 0.003/p = 0.002）。每周至少遇到一名佝偻病患者的医生（n = 78，39.4%）对正常血清25-羟基维生素D3水平有更好的了解（p = 0.042），且将患者转诊至儿科内分泌科医生的可能性显著降低（p < 0.001）。
土耳其骨科和创伤科专家对佝偻病的管理方法因临床经验、实践环境以及是否有儿科内分泌科医生而有显著差异。为防止治疗不足和不必要的转诊，骨科诊所新诊断的佝偻病患者应进行适当评估，并在必要时转诊。强烈建议根据国际指南制定标准化的诊断和转诊算法，并将其纳入骨科培训项目。
