JAMA, the cozy new home for our FISH

The FISH trial, our RCT on humeral shaft fractures, reached a noteworthy milestone, as the 1-year results were published in the prestigious Journal of American Medical Association (JAMA) on May 12, 2020.

The journey began in 2010 when I (Lasse Rämö) – a young orthopedic resident at the time – sealed my destiny for a long time: While on call, I had to make a choice between taking the stairs or stepping into the elevator with my boss Mika Paavola. It didn’t take us long to start a conversation about possible research projects. As a hard-core upper extremity surgeon, Mika proposed that I carry out a trial on humeral shaft fractures, since Mika told me the optimal treatment strategy posed a challenge even to the specialists. Although I immediately appreciated the magnitude of the task at hand, I was far too tempted to turn down the offer. A week later, we arranged the kickoff of the FISH trial.

With the help of a group of talented clinicians and researchers from Helsinki and Tampere University Hospitals, we formed the FISH study group and started recruiting patients in 2012. Obviously, there was a lot of blood and tears shed prior to the launch from exhaustive planning and preparation for the trial. We published our study protocol in 2017.

Finally in January 2018, we completed the recruitment phase and after a nerve-wracking 1-year wait to complete the follow-up, we were all set to analyze the data and write the manuscript.

I won’t get into details, rather just state that the path from the initial submission to the final acceptance was one sort of mental roller-coaster. But here I am, happy and proud that our paper (and I) survived the JAMA scrutiny: What a relief it was to receive the much waited email from the Deputy Editor Edward Livingston that stated the magical sentence: “We will accept this manuscript for publication in JAMA”.

Ten years, countless number of visits to the ER, sleepless nights, but finally… It is time to harvest the crop!

My only advice to young surgical residents on call with your boss: Take the stairs instead of the elevator… However, if you want to push your limits and have an experience of a life-time (but probably live a slightly shorter life), step into the elevator! This was a ride that money can’t buy!

Lasse and Mika, the founding fathers of the FISH trial, are good friends even after 10 years of hard work!