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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.
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| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Instructional video | Other | 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). | ||
| Reduction algorithm | Other | 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. |
| Measure | Description | Time Frame |
|---|---|---|
| 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 | 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 | 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 | 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 | 6 months after hip surgery |
| Measure | Description | Time Frame |
|---|---|---|
| Hip re-operations | Number of re-operations due to loss of reduction | 6 months after hip surgery |
| Mortality | Number of patients that have died |
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Inclusion Criteria:
Exclusion Criteria:
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Patients presenting with an intertrochanteric fracture or subtrochanteric fracture at the Department of Orthopaedic and Traumatology, University Hospital Basel
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| Name | Affiliation | Role |
|---|---|---|
| Henrik Eckardt, PD Dr. med | Department of Orthopaedics and Traumatology, University Hospital Basel | Principal Investigator |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Department of Orthopaedics and Traumatology, University Hospital Basel | Basel | 4031 | Switzerland |
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| ID | Term |
|---|---|
| D006620 | Hip Fractures |
| ID | Term |
|---|---|
| D005264 | Femoral Fractures |
| D050723 | Fractures, Bone |
| D014947 | Wounds and Injuries |
| D025981 | Hip Injuries |
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| 6 months after hip surgery |
| Operation time from incision until closure of the wound (minutes) | Operation time from incision until closure of the wound | second postoperative day |
| Central placement of the femoral neck screw (degree) | Radiologic result: Central placement of the femoral neck screw as measured with the Tip-Apex-Distance | second postoperative day |
| Reduction of the calcar segment in the lateral view (mm) | Radiologic result: Reduction of the calcar segment in the lateral view | second postoperative day |
| D007869 |
| Leg Injuries |