Fellowship-Trained Orthopaedic Trauma Surgeons Achieve Better Postoperative Radiographic Parameters After Intramedullary Nailing of Intertrochanteric Femur Fractures when Compared With Non-trauma-Trained Surgeons

被引:0
作者
Shaath, M. Kareem [1 ]
Yawman, Jonathan [2 ]
Anderson, Tyler [2 ]
Avilucea, Frank R. [1 ]
Langford, Joshua R. [1 ]
Munro, Mark W. [1 ]
Haidukewych, George J. [1 ]
机构
[1] Univ Cent Florida, Orlando Hlth Orthoped Inst, Florida State Coll Med, Coll Med, Orlando, FL 32816 USA
[2] Orlando Hlth Jewett Orthoped Inst, Orlando, FL USA
关键词
PROXIMAL FEMORAL NAIL; SLIDING HIP SCREW; TIP-APEX DISTANCE; LAG SCREW; HELICAL BLADE; CUTTING-OUT; FIXATION; FAILURE; REDUCTION; QUALITY;
D O I
10.5435/JAAOS-D-22-00877
中图分类号
R826.8 [整形外科学]; R782.2 [口腔颌面部整形外科学]; R726.2 [小儿整形外科学]; R62 [整形外科学(修复外科学)];
学科分类号
摘要
Introduction:Intertrochanteric femoral fractures are common orthopaedic injuries accounting for nearly 30% of all fracture-related hospitalizations. Because many factors predictive of failure are related to technical aspects of the surgery, the purpose of this study was to compare radiographic parameters after fixation, comparing fellowship-trained orthopaedic trauma surgeons with surgeons who did not complete an orthopaedic trauma fellowship.Methods:We initiated a search for CPT code 27245 across our hospital network to identify 100 consecutive patients treated by five fellowship-trained orthopaedic traumatologists and 100 consecutive patients treated by community surgeons. Patients were then stratified based on their surgeon's subspecialty training (trauma vs community). Primary outcome variables were neck-shaft angle (NSA), a comparison of the repaired NSA with the uninjured side, tip-apex distance, and reduction quality.Results:One hundred patients were included in each group. The mean age in the community group was 77 years compared with 79 years in the trauma group. The mean tip-apex distance for the trauma group was 10 mm compared with 21 mm for the community group (P < 0.001). The mean postoperative NSA for the trauma group was 133 & DEG; compared with 127 & DEG; for the community group (P < 0.001). The mean difference of the NSA of the repaired side compared with the uninjured side was 2.5 & DEG; of valgus in the trauma group compared with 5 & DEG; of varus for the community group (P < 0.001). There were 93 good reductions in the trauma group compared with 19 in the community group (P < 0.001). There were 0 poor reductions in the trauma group and 49 in the community group (P < 0.001).Discussion:Overall, we have shown that fellowship-trained orthopaedic trauma surgeons achieve better reductions when treating intertrochanteric femur fractures with intramedullary nails. Orthopaedic residency training should emphasize teaching proper techniques and acceptable parameters for reduction and implant placement when treating geriatric intertrochanteric femur fractures.
引用
收藏
页码:995 / 1000
页数:6
相关论文
共 27 条
[1]   Tip apex distance, hip screw placement, and neck shaft angle as potential risk factors for cut-out failure of hip screws after surgical treatment of intertrochanteric fractures [J].
Andruszkow, Hagen ;
Frink, Michael ;
Froemke, Cornelia ;
Matityahu, Amir ;
Zeckey, Christian ;
Mommsen, Philipp ;
Suntardjo, Stefanie ;
Krettek, Christian ;
Hildebrand, Frank .
INTERNATIONAL ORTHOPAEDICS, 2012, 36 (11) :2347-2354
[2]  
[Anonymous], 2002, J BONE JOINT SURG AM, V84A, P670
[3]  
[Anonymous], 1990, NAT HOSP DISCH SURV
[4]   THE VALUE OF THE TIP-APEX DISTANCE IN PREDICTING FAILURE OF FIXATION OF PERITROCHANTERIC FRACTURES OF THE HIP [J].
BAUMGAERTNER, MR ;
CURTIN, SL ;
LINDSKOG, DM ;
KEGGI, JM .
JOURNAL OF BONE AND JOINT SURGERY-AMERICAN VOLUME, 1995, 77A (07) :1058-1064
[5]   Critical factors in cut-out complication after gamma nail treatment of proximal femoral fractures [J].
Bojan, Alicja J. ;
Beimel, Claudia ;
Taglang, Gilbert ;
Collin, David ;
Ekholm, Carl ;
Jonsson, Anders .
BMC MUSCULOSKELETAL DISORDERS, 2013, 14
[6]   Helical Blade Versus Screw Fixation in the Treatment of Hip Fractures With Cephalomedullary Devices: Incidence of Failure and Atypical "Medial Cutout" [J].
Chapman, Talia ;
Zmistowski, Benjamin ;
Krieg, James ;
Stake, Seth ;
Jones, Christopher M. ;
Levicoff, Eric .
JOURNAL OF ORTHOPAEDIC TRAUMA, 2018, 32 (08) :397-402
[7]   INTERTROCHANTERIC FEMORAL FRACTURES - MECHANICAL FAILURE AFTER INTERNAL-FIXATION [J].
DAVIS, TRC ;
SHER, JL ;
HORSMAN, A ;
SIMPSON, M ;
PORTER, BB ;
CHECKETTS, RG .
JOURNAL OF BONE AND JOINT SURGERY-BRITISH VOLUME, 1990, 72 (01) :26-31
[8]   Central Head Perforation, or "Cut Through," Caused by the Helical Blade of the Proximal Femoral Nail Antirotation [J].
Frei, Hans-Curd ;
Hotz, Thomas ;
Cadosch, Dieter ;
Rudin, Mark ;
Kaech, Kurt .
JOURNAL OF ORTHOPAEDIC TRAUMA, 2012, 26 (08) :E102-E107
[9]   Tip-apex distance of intramedullary devices as a predictor of cut-out failure in the treatment of peritrochanteric elderly hip fractures [J].
Geller, Jeffrey A. ;
Saifi, Comron ;
Morrison, Todd A. ;
Macaulay, William .
INTERNATIONAL ORTHOPAEDICS, 2010, 34 (05) :719-722
[10]   Failure of femoral head fixation: a cadaveric analysis of lag screw cut-out with the gamma locking nail and AO dynamic hip screw [J].
Haynes, RC ;
Poll, RG ;
Miles, AW ;
Weston, RB .
INJURY-INTERNATIONAL JOURNAL OF THE CARE OF THE INJURED, 1997, 28 (5-6) :337-341