Gombera Mufaddal M, Morris Brent J, Elkousy Hussein A, Laughlin Mitzi S, Vidal Emily A, Brinker Mark R
Fondren Orthopedic Group L.L.P., Texas Orthopedic Hospital, 7401 Main Street, Houston, TX, 77030, USA.
Fondren Orthopedic Research Institute (FORI), 7401 Main Street, Houston, TX, 77030, USA.
J Clin Orthop Trauma. 2020 Sep 6;13:24-29. doi: 10.1016/j.jcot.2020.08.025. eCollection 2021 Feb.
The purpose of this study was to evaluate whether fellowship training affected trends and complications of operative clavicle fracture treatment in newly trained orthopedic surgeons.
The American Board of Orthopedic Surgery (ABOS) database was utilized to identify cases of open treatment of clavicle fractures submitted by ABOS Part-II Board Certification candidates. From 2005 to 2017, 3148 candidates performed at least one open clavicle fracture treatment. Overall, 6919 cases were included; 3516 of these had over 6 weeks of follow-up. Candidates were divided by fellowship type into 5 groups: Trauma, Sports Medicine, Hand and Upper Extremity or Shoulder, multiple, and other or no fellowship(s). Group differences were analyzed with ANOVA and Bonferroni post hoc analysis. Complications, reoperations, nonunion rates, and readmissions between groups were evaluated with Chi-squared test and logistic regression analyses.
Case volume during the study period was significantly higher after 2007. Trauma candidates performed significantly more operations for clavicle fracture per candidate while candidates with other or no fellowship(s) performed significantly fewer operations per candidate. Patients treated by Trauma candidates were significantly older, had significantly fewer early surgical complications and significantly more early medical complications. Nonunion rates were not significantly different between groups.
Candidates treated clavicle fractures surgically more often in 2007 and beyond. Trauma candidates treated older patients, had fewer early surgical complications, and had more medical complications. Reoperation, readmission and nonunion rates were not significantly different between groups.
本研究旨在评估专科培训是否会影响新培训的骨科医生治疗锁骨骨折手术的趋势及并发症情况。
利用美国骨科医师委员会（ABOS）数据库，识别ABOS第二部分委员会认证候选人提交的锁骨骨折开放治疗病例。2005年至2017年，3148名候选人至少进行了一次锁骨骨折开放治疗。总共纳入6919例病例；其中3516例有超过6周的随访。候选人按专科类型分为5组：创伤、运动医学、手与上肢或肩部、多个专科、其他或无专科培训。采用方差分析和Bonferroni事后分析对组间差异进行分析。采用卡方检验和逻辑回归分析评估组间并发症、再次手术、骨不连发生率和再入院情况。
2007年后研究期间的病例数量显著增加。创伤专科候选人每名候选人进行的锁骨骨折手术显著更多，而接受其他或无专科培训的候选人每名候选人进行的手术显著更少。接受创伤专科候选人治疗的患者年龄显著更大，早期手术并发症显著更少，早期医疗并发症显著更多。组间骨不连发生率无显著差异。
2007年及以后，候选人进行锁骨骨折手术的频率更高。创伤专科候选人治疗的患者年龄更大，早期手术并发症更少，医疗并发症更多。组间再次手术、再入院和骨不连发生率无显著差异。
