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

Abstract

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 fellowshiptrained 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°compared with 127°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°of valgus in the trauma group compared with 5°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).

Anteromedial Cortical Support in Reduction of Trochanteric Hip Fractures

“…The AMCS-Related Fracture Reduction Criteria: CRQC In 1995, Baumgaertner et al 7 proposed the Baumgaertner reduction quality criteria (BRQC) for trochanteric hip fractures, which included evaluations of alignment and displacement (Table II). Although the BRQC have seen broad adoption in clinical studies 53,54 , it was also noted early that the importance of anteromedial reduction was not taken into consideration 55 . In 2015, the CRQC were introduced upon integration of the foundation set by the BRQC and the AMCS concept (Table III) 9 .…”