Implications of a Specialist Hip Fracture Service on Outcomes after Internal Fixation of a Trochanteric Hip Fracture

Description

In this presentation, Alexandra Macmillan, a ST3 Registrar in Peterborough, discusses the outcomes of trochanteric hip fractures and their fixation methods. Highlighting the commonality of these fractures and the variability in surgical expertise, she emphasizes a study aimed to compare outcomes based on the surgical grade of practitioners—specifically contrasting those led by a specialized hip fracture surgeon with those performed by orthopedic trainees or consultants of different specialties.



The research encompassed a 22-year analysis of a prospectively collected hip fracture database, focusing on A1, A2, and A3 fracture types while excluding patients under 60 and those with pathological fractures. The findings reveal that over 1,800 patients were treated by specialist surgeons, with comparable demographics across groups. Notably, the surgery duration for sliding hip screws averaged 53 minutes for specialists compared to 80 minutes for others, while intramedullary nails took 55 minutes for specialists versus over two hours for the other surgeons, with these differences deemed statistically significant.



Complication rates for sliding hip screws did not differ significantly, yet intramedullary nails showed a stark contrast: only 1% of surgeries by specialists resulted in cut-outs versus nearly 10% from non-specialists, alongside a revision necessity of about 1.5% compared to 8%. While the study highlighted substantial findings in terms of complication rates, other metrics such as sepsis rates and mortality showed no significant discrepancies.



She concludes that while sliding hip screw fixations are effective across various skill levels, A2 type fractures utilizing intramedullary nails warrant a specialist's oversight for optimal outcomes, proposing this as an important consideration for future surgical service planning.

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