The role of a trauma review system and development of intra-operative checklists in improving the quality of fracture fixations in a high volume tertiary centre

Rajasekaran, Raja Bhaskara; Jayaramaraju, Dheenadhayalan; Devendra, Agraharam; Perumal, Ramesh; Kamal, Arun; Rajasekaran, Shanmuganathan

doi:10.1007/s00068-020-01317-0

Cited by 1 publication

(1 citation statement)

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“…The study did not provide outcome data on post-operative complications, infection or delayed revisions, but it does demonstrate a clear stepwise improvement upon the instigation of a robust consultant-led, peer review process. From their study, they were able to identify higher-risk fractures pre-operatively and allocate an appropriately experienced surgeon to perform the operation with the added motivation of peer review post-operatively [ 13 ].…”

Section: Discussionmentioning

confidence: 99%

Unsatisfactory Post-operative Imaging Is Predictive of Revision Surgery in Intracapsular Hip Fracture Fixation

Whittaker,

Farrow,

Neilly

et al. 2024

Cureus

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Failed fixation of intracapsular hip fractures in young patients is associated with high morbidity and cost. Accordingly, we set out to determine the association between unsatisfactory post-operative imaging (judged by two fellowship-trained trauma consultants and a senior trainee) and the risk of subsequent reoperation, including adjustment for potential confounding variables. Ninety-four (94) patients aged <60 were included in the study from a single major trauma centre. Exhausted patients (19%) required further surgery, with the most common reason being avascular necrosis (n=10) followed by non-union (n=6). Univariate analysis found only smokers and unsatisfactory fracture reduction to be predictive of failure (p < 0.05). Other demographics and recognised scoring systems from the literature were poor predictors of failure apart from the Haiduewych classification system, utilised to assess the quality of reduction, which showed a trend towards significance (p0.053). Multivariate analysis showed smoking and unsatisfactory fracture reduction to be strong predictors of failure (p<0.05). In those with unsatisfactory fracture reduction, 50% required reoperation compared to 17.5% of those with satisfactory reduction. This study highlights the key principles of ensuring adequate intraoperative reduction and fixation, in keeping with GIRFT principles. Avoiding secondary reoperation is crucial to prevent long-term negative outcomes for this typically high functional demand group of patients. We recommend regular, consultant peer review of post-operative imaging as a method of identifying substandard fracture fixations and those at risk of failure. This will allow opportunities for teaching, clinical improvement, and multidisciplinary team (MDT) discussions of at-risk patients.

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Section: Discussionmentioning

confidence: 99%