Wittauer Matthias, Sklorz Pavel, Przybilla Philip, Vach Werner, Eckardt Henrik
Department of Orthopaedic and Trauma Surgery, University Hospital Basel, Switzerland; University of Basel, Basel, Switzerland.
Department of Orthopaedic and Trauma Surgery, University Hospital Basel, Switzerland; University of Basel, Basel, Switzerland.
Injury. 2025 Feb;56(2):112146. doi: 10.1016/j.injury.2025.112146. Epub 2025 Jan 8.
Intertrochanteric fractures are common in older adults and pose significant challenges in terms of morbidity and mortality. Accurate reduction and optimal implant positioning during operative stabilisation of these fractures reduce the rates of complications and reoperations while improving functional outcomes in this population. This study aimed to assess the effects of a structured educational intervention on the radiographic outcomes, reduction quality, and revision rates of intertrochanteric fractures.
We initiated a training program that included an instructional video on interpreting intraoperative fluoroscopic views, as well as instructions and an algorithm for reducing and stabilising intertrochanteric fractures and mandated its implementation for all operating surgeons. We thus established an intervention cohort (n = 209) of patients who underwent surgery after the program's introduction, which we compared with a historical control cohort (n = 207) of patients who had undergone surgery before the program's implementation. The analysed postoperative radiographic parameters included the Baumgaertner reduction index, tip-apex distance (TAD), restoration of the caput-collum-diaphyseal angle, and calcar displacement. Mortality and the need for revision surgery were monitored for 2 years postoperatively.
We observed significant improvements in the intervention cohort, particularly among the less experienced surgeons. The TAD was reduced by 7 %, indicating improved implant positioning. Similarly, the Baumgaertner reduction index revealed an increase in 'good' reductions (40.2% vs. 37.2 %). Additionally, the rates of revision surgery (4.8% vs. 11.1 %) and mechanical complications (1.9% vs. 6.3 %) were lower in the intervention cohort than in the control cohort.
Implementation of the structured training program led to better radiographic outcomes for intertrochanteric fractures, especially among less experienced surgeons. The observed improvements in reduction quality and decrease in revision rates underscore the potential benefits of incorporating educational interventions in orthopaedic trauma treatment.
转子间骨折在老年人中很常见，在发病率和死亡率方面带来重大挑战。在这些骨折的手术稳定过程中进行准确复位和优化植入物定位，可降低并发症和再次手术的发生率，同时改善该人群的功能结局。本研究旨在评估结构化教育干预对转子间骨折的影像学结果、复位质量和翻修率的影响。
我们启动了一项培训计划，其中包括一个关于解读术中透视影像的教学视频，以及关于转子间骨折复位和稳定的指导及算法，并要求所有手术外科医生执行。因此，我们建立了一个干预队列（n = 209），该队列中的患者在该计划推出后接受了手术，并将其与一个历史对照队列（n = 207）进行比较，后者为在该计划实施前接受手术的患者。分析的术后影像学参数包括鲍姆加特纳复位指数、尖顶距（TAD）、头颈干角的恢复情况以及股骨距移位。术后2年监测死亡率和翻修手术的需求。
我们在干预队列中观察到了显著改善，尤其是在经验较少的外科医生中。TAD降低了7%，表明植入物定位得到改善。同样，鲍姆加特纳复位指数显示“良好”复位的比例有所增加（40.2%对37.2%）。此外，干预队列中的翻修手术率（4.8%对11.1%）和机械并发症发生率（1.9%对6.3%）低于对照队列。
实施结构化培训计划可使转子间骨折获得更好的影像学结果，尤其是在经验较少的外科医生中。观察到的复位质量改善和翻修率降低突出了在骨科创伤治疗中纳入教育干预的潜在益处。
