Subspecialty Fellowship Training Is Not Associated With Better Outcomes in Fixation of Low-Energy Femoral Neck Fractures-An Analysis of the Fixation Using Alternative Implants for the Treatment of Hip Fractures Database.

Autor:	DeAngelis RD; Department of Orthopaedic Surgery, University of Pennsylvania, Philadelphia, PA., Stein MK; Department of Orthopaedic Surgery, University of Pennsylvania, Philadelphia, PA., Minutillo GT; Department of Orthopaedic Surgery, University of Pennsylvania, Philadelphia, PA., Mehta NG; Department of Orthopaedic Surgery, University of Pennsylvania, Philadelphia, PA., Schemitsch EH; Department of Surgery, University of Western Ontario, London, ON, Canada., Bzovsky S; Division of Orthopaedic Surgery, Department of Surgery, McMaster University, Hamilton, ON, Canada., Sprague S; Division of Orthopaedic Surgery, Department of Surgery, McMaster University, Hamilton, ON, Canada.; Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada; and., Bhandari M; Division of Orthopaedic Surgery, Department of Surgery, McMaster University, Hamilton, ON, Canada.; Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada; and., Swiontkowski M; Department of Orthopaedic Surgery, University of Minnesota, Minneapolis, MN ., Donegan DJ; Department of Orthopaedic Surgery, University of Pennsylvania, Philadelphia, PA., Mehta S; Department of Orthopaedic Surgery, University of Pennsylvania, Philadelphia, PA.
Jazyk:	angličtina
Zdroj:	Journal of orthopaedic trauma [J Orthop Trauma] 2022 Apr 01; Vol. 36 (4), pp. 208-212.
DOI:	10.1097/BOT.0000000000002264
Abstrakt:	Objectives: To compare risk of reoperation for femoral neck fracture patients undergoing fixation with cancellous screws (CSs) or sliding hip screws based on surgeon fellowship (trauma-fellowship-trained vs. non-trauma-fellowship-trained). Design: Retrospective review of Fixation using Alternative Implants for the Treatment of Hip fractures data. Setting: Eighty-one centers across 8 countries. Patients/participants: Eight hundred nineteen patients ≥50 years old with low-energy hip fractures requiring surgical fixation. Intervention: Patients were randomized to CS or sliding hip screw group in the initial dataset. Main Outcome Measurements: The primary outcome was risk of reoperation. Secondary outcomes included death, serious adverse events, radiographic healing, discharge disposition, and use of ambulatory devices postoperatively. Results: There was no difference in risk of reoperation between the 2 surgeon groups (P > 0.05). Patients treated by orthopaedic trauma surgeons were more likely to be overweight/obese and have major medical comorbidities (P < 0.05). There was a higher risk of serious adverse events, higher likelihood of radiographic healing, and higher odds of discharge to a facility for patients treated by trauma-fellowship-trained surgeons (P < 0.05). Conclusions: Based on these data, risk of reoperation for low-energy femoral neck fracture fixation is equivalent regardless of fellowship training. The higher likelihood of radiographic healing noted in the trauma-trained group does not seem to have a major clinical implication because it did not affect risk of reoperation between the 2 groups. Patient-specific factors present preinjury, such as body habitus and medical comorbidities, may account for the lower odds of discharge to home and higher risk of postoperative medical complications for patients treated by orthopaedic trauma surgeons. Level of Evidence: Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence. Competing Interests: R. D. DeAngelis reports paid consultant for Arbutus Medical Inc., outside the submitted work. D. J. Donegan reports paid consultant for DePuy and Johnson & Johnson Company, outside the submitted work. E. H. Schemitsch reports personal fees from Acumed, LLC, personal fees from Amgen Co, research support from Biocomposites, board or committee member for the Canadian Orthopaedic Association, personal fees from DePuy, personal fees from Heron Therapeutics, personal fees from ITS, editorial or governing board for the Journal of Orthopaedic Trauma, board or committee member for the Orthopaedic Trauma Association, editorial or governing board for the Orthopaedic Trauma Association International, board or committee member for the Osteosynthesis and Trauma Care Foundation, personal fees from Pentopharm, personal fees from Sanofi-Aventis, personal fees from Saunders/Mosby-Elsevier, personal fees from Smith & Nephew, personal fees from Springer, personal fees from Stryker, personal fees from Swemac, personal fees from Synthes, and personal fees from Zimmer, outside the submitted work. S. Sprague reports editorial or governing board for BMS Women's Health, employment from Global Research Solutions Inc., and employment from McMaster University, outside the submitted work. M. Bhandari reports personal fees from AgNovos Healthcare, research support from Canadian Institutes of Health Research, board or committee member for the International Society of Orthopaedic Surgery and Traumatology, research support from the National Institutes of Health (NIAMS & NICHD), research support from Physicians' Services Incorporated, personal fees from Sanofi-Aventis, personal fees from Smith & Nephew, and research support from the US Department of Defense, outside the submitted work. S. Mehta reports research support from Acumed, LLC, board or committee member for AO Foundation, paid presenter or speaker for Bioventus, editorial or governing board for Current Opinion in Orthopaedics, paid presenter or speaker for DePuy and Johnson & Johnson Company, board or committee member for the Orthopaedic Trauma Association, paid consultant and paid presenter or speaker for Smith & Nephew, paid consultant and research support for Synthes, publishing royalties, financial or material support from Wolters Kluwer Health—Lippincott Williams & Wilkins, and research support from Zimmer, outside the submitted work. M. Swiontkowski reports board or committee member for the American Orthopaedic Association, consultant to the Minnesota Board of Medical Practice, editorial or governing board, publishing royalties, and financial or material support for the Journal of Bone and Joint Surgery—American, and publishing royalties and financial or material support from Wolters Kluwer Health—Lippincott Williams & Wilkins, outside the submitted work. The remaining authors report no conflict of interest. (Copyright © 2021 Wolters Kluwer Health, Inc. All rights reserved.)
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