Intramedullary Fixation of Trochanteric Fractures Can Be Safely Performed by Senior Residents Without Immediate Consultant Supervision

• Published in: Journal of surgical education Vol. 79; no. 1; pp. 260 - 265
• Main Authors: Halonen, Lauri M, Stenroos, Antti, Vasara, Henri, Kosola, Jussi
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01-01-2022
• Subjects: Bone Nails; Consultants; Hip fracture; Hip Fractures - surgery; Humans; Retrospective Studies; Safe surgery; Surgical education; Treatment Outcome; Trochanteric fracture; Safe surgery; Patient Care; Hip fracture; Trochanteric fracture; Surgical education; Systems-Based Practice; Practice-Based Learning and Improvement; Professionalism
• ISSN: 1931-7204; 1878-7452
• DOI: 10.1016/j.jsurg.2021.06.026

To assess the safety of senior residents performing trochanteric hip fracture surgery without immediate consultant supervision
A retrospective chart review of trochanteric hip fractures (AO-OTA 31-A) operated in a single center between years 2011 and 2016 (inclusive). Operations were divided into three groups: Group 1 - surgeon was a senior resident without any immediate supervision; Group 2 - surgeon was a consultant and Group 3 - surgeon was a senior resident supervised by a consultant. The follow-up period was a minimum of 2 years or until death. All re-operations and surgical related mortality were assessed.
Helsinki University Hospital, Finland. A tertiary level trauma center.
987 consecutive trochanteric fractures on 966 patients treated by operative fixation of an intertrochanteric fracture with an intramedullary nail between 2011and 2016 (inclusive).
The total number of reoperations was smaller in Group 1 where the surgeon was a senior resident without any immediate supervision compared to Group 2 where the surgeon was a consultant (5.5 % vs 8.8 %, p < 0.05). There were no significant differences in mortality or length of surgery. The total rate of mechanical complications was 2.0 %, with no significant differences between groups. The observed blade cut-out rate was low: 1.3 %, suggesting a good overall quality of surgery.
Senior residents can safely perform intramedullary nailing of trochanteric fractures without immediate supervision.