Learning curves in hip fracture surgery

The aim of this study was to identify and characterise learning curves in hip fracture surgery. Operating times were collected and related to the number of procedures done by residents performing closed reduction and internal fixation using cannulated screws for intracapsular fractures of the hip and cephalomedullary nailing for trochanteric fractures, as well as hemiarthroplasty for displaced intracapsular fractures. The mean operating times decreased significantly for all four procedures studied, though at different rates. For cannulated screws, the mean duration of surgery decreased from 47.8 minutes to 30.1 minutes for procedures 21-25. For cephalomedullary nailing without distal locking, the mean operating time decreased from 73.3 minutes to 36.3 minutes. For cephalomedullary nailing with distal locking, the mean operating time decreased from 81.7 minutes to 56.9 minutes. The mean operating time for hemiarthroplasty decreased from 97.3 minutes to 66.0 minutes. Mean operating times decreased significantly for all procedures studied, though at different rates, indicating a unique learning curve for each procedure.