This prospective study (including patients with an intertrochanteric or subtrochanteric fractures type 31A1, 31A2 and 31A3) is to assess the effect of an educational intervention for operating surgeons with respect to an improvement of the quality of reduction and internal stabilisation of intertrochanteric fractures. A historic cohort of patients operated at the University Hospital Basel for an intertrochanteric fracture from 2014-2015 will be used for comparison.
Intertrochanteric fractures are one of the most frequent fracture type in the elderly population usually occurring in patients older than 60 years of age. Almost all fractures are treated operatively with reduction and stabilisation of the fracture using either a dynamic hip screw or an intramedullary nail. The reduction of the fracture and positioning of the implant are surgeon dependent factors and can be influenced by educational interventions. The investigators hypothesized that a structured educational program on the optimal use of intraoperative fluoroscopy to control the quality of reduction and the position of the implant, as well as the provision of a practical algorithm intraoperatively guiding reduction and stabilisation of intertrochanteric fractures would improve the radiologic outcome.
Study Type
OBSERVATIONAL
Enrollment
250
Video (produced by AO Trauma and Prof. Daniel Rikli) includes a stepwise and structured explanation of the different fluoroscopic views necessary to evaluate intraoperatively with the fluoroscope different aspects of the proximal femur. The video is publically available under: (https://www.aointeract.org/#/watch/video/L3YxL3ZpZGVvcy8xOTc=/intraoperative-imaging-of-femur).
Intraoperative reduction algorithm (developed by PD Henrik Eckardt); each step in the algorithm will be checked and documented with the fluoroscope and archived using the store function of the fluoroscope.
Department of Orthopaedics and Traumatology, University Hospital Basel
Basel, Switzerland
Shortening of the femoral neck (mm)
Radiologic result: Shortening of the femoral neck as measured with sliding of the femoral neck screw inside the nail
Time frame: 6 months after hip surgery
Change of the shaft-neck angle (degree)
Radiologic result: Change of the shaft-neck angle on the antero-posterior view in comparison to postoperative value
Time frame: 6 months after hip surgery
Displacement of the calcar segment in the lateral view
Radiologic result: Displacement of the calcar segment in the lateral view
Time frame: 6 months after hip surgery
Central placement of the femoral neck screw (degree)
Radiologic result: Central placement of the femoral neck screw as measured with the Tip-Apex-Distance
Time frame: 6 months after hip surgery
Hip re-operations
Number of re-operations due to loss of reduction
Time frame: 6 months after hip surgery
Mortality
Number of patients that have died
Time frame: 6 months after hip surgery
Operation time from incision until closure of the wound (minutes)
Operation time from incision until closure of the wound
Time frame: second postoperative day
Central placement of the femoral neck screw (degree)
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Radiologic result: Central placement of the femoral neck screw as measured with the Tip-Apex-Distance
Time frame: second postoperative day
Reduction of the calcar segment in the lateral view (mm)
Radiologic result: Reduction of the calcar segment in the lateral view
Time frame: second postoperative day