Trauma surgery by general surgeons: Still an option for proximal femoral fractures?

Treskes, Kaij; Voeten, Stijn C.; Tol, Maria C J M; Zuidema, Wietse P.; Vermeulen, Jefrey; Goslings, J. Carel; Schep, N.W.L.; Brand, Johan G. H. van den; Velde, Romuald van; Haverlag, Robert; Ultee, Jan M.; Postma, V.A.; Twigt, Bas A; Dijkman, Bart A. van; Heres, Pieter; Winkelhagen, Jasper; Klooster, Mariska; Toor, E.J.

doi:10.1016/j.injury.2016.11.020

Cited by 7 publications

(5 citation statements)

References 7 publications

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“…Differences in outcome for patients with proximal femoral fractures operated by trauma-certified surgeons versus non-trauma certified general surgeons have been studied before and presented various results. Some studies suggested trauma certification to be associated with shorter time to operation but apart from one study that indicated certification to be associated with fewer reoperations and surgical site infections [14] , no direct relation with better outcomes has been established so far. [ 15 , 16 ].…”

Section: Discussionmentioning

confidence: 99%

Variation in treatment of hip fractures and guideline adherence amongst surgeons with different training backgrounds in the Netherlands

Würdemann

Voeten

Krijnen

et al. 2022

Injury

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Background and Purpose: Two medical specialties, general surgery and orthopaedic surgery, with different training programs but matching trauma certification requirements, provide hip fracture surgery in the Netherlands. This study analyses treatment preferences and guideline adherence of Dutch surgeons with different surgical backgrounds.Patients and Methods: All hip fracture patients registered in the Dutch Hip Fracture Audit in 2018 and 2019 were included in this retrospective study. Four types of surgeons were distinguished: trauma-certified general surgeons (ST + ), non-trauma certified general surgeons (ST-), trauma-certified orthopaedic surgeons (OT + ) and non-trauma certified orthopaedic surgeons (OT-). Differences in patient characteristics, and practice variation in treatment choices and guideline adherence per fracture type were analysed using descriptive statistics.Results: 28,656 patients were included; 16,367 (57.1%) treated by ST + , 1,371 (4.8%) by ST-, 4,692 (16.4%) by OT + and 6,226 (21.7%) by OT-. Few clinically relevant differences in patient characteristics and hospital processes were found between all surgeon groups. Displaced FNF were the most commonly treated fracture type for all types of surgeons. Both OT + and OT-operated mostly (displaced) FNFs, while the fracture types treated by ST + and ST-were more heterogeneous. For all fracture types, the orthopaedic surgeons performed THA and HA more often than general surgeons, while general surgeons more often placed SHS and IMN for specific fracture types. Guideline adherence was on average 68.4% and differed significantly per surgeon type (68.7% by ST + , 65.2% by ST-, 74.4% by OT + and 63.6% by OT-( p < 0.01)), as well as per fracture type: > 90% treatment according to the guideline for trochanteric AO-31A2 and A3 fractures, 18.8% for AO-31A1 fractures and 51.7% guideline adherence for undisplaced FNF. Guideline adherence for displaced FNF varied depending on patient characteristics.Discussion: In the Netherlands, different surgical specialists treat different types of hip fractures and have different preferences concerning implants for hip fracture surgery in comparable patients. Guideline adherence of trauma-and non-trauma certified orthopaedics and general surgeons differs significantly. Reduction of practice variation should be strived for in order to improve hip fracture care.

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Section: Discussionmentioning

confidence: 99%

Variation in treatment of hip fractures and guideline adherence amongst surgeons with different training backgrounds in the Netherlands

Würdemann

Voeten

Krijnen

et al. 2022

Injury

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“…In surgery, reserved blood supply and good nutrition for the fracture ends provide a good biological environment for bone union 16 . The periosteum was protected and kept as intact as possible to promote fracture healing through ESIN 17 . Qu et al selected 100 cases with limb long bone fractures as research objects and their results showed that the hospitalization time, fracture healing time, and intraoperative blood loss in the patients treated with ESIN were much less than those in the patients with MPIF 5 .…”

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Clinical Efficacy of Minimally Invasive Elastic Stable Intramedullary Nailing for Limb Long Bone Fractures in Children

Liu

Wang

Qin

et al. 2021

Orthopaedic Surgery

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The aim of the present paper was to investigate the clinical efficacy of minimally invasive elastic stable intramedullary nailing (ESIN) for long bone fractures in children.Methods: A total of 350 children with limb fractures from June 2012 to June 2018 were recruited and randomized into two groups: an ESIN group (n = 175) treated with elastic stable intramedullary nailing, and an MPIF group (n = 175), treated with metal plate internal fixation. Both groups received the same physical examination and routine medication. Operation related indexes, clinical efficacy, complications, and postoperative quality of life scores were analyzed and compared. Results:The operation time, intraoperative blood loss, hospitalization time, and fracture healing time in the ESIN group were 43.74 AE 4.96 min, 8.14 AE 1.34 mL, 5.97 AE 1.88 days, and 55.89 AE 5.61 days, respectively, which were all significantly less than those in the MPIF group (all P < 0.001). In terms of common complications after limb fracture treatment, there were 6 cases of osteomyelitis, 5 cases of skin irritation response, and 7 cases of inflammatory granuloma in the MPIF group. There were 2 cases of skin irritation response and 5 cases of inflammatory granuloma in the ESIN group. The incidence of postoperative complications in the ESIN group was 4.00%, which was significantly lower than that in MPIF group (10.29%) (P < 0.05). The effective rate for recovery condition in the ESIN group (93.71%) was significantly higher than that in the MPIF group (P < 0.001). The quality of life scores after treatment in both groups were improved, while the score in the ESIN group was significantly higher than that in the MPIF group (79.43%) (P < 0.001). The postoperative satisfaction rate in the ESIN group (94.29%) was significantly higher than that in the MPIF group (86.29%) (P < 0.05). The quality of life scores after treatment in both groups were improved, while the score in the ESIN group was significantly higher than that in the MPIF group (P < 0.001). The postoperative satisfaction rate and the acceptance rate for adjacent joint function in the ESIN group (100%) were significantly higher than those in the MPIF group (92.00%) (P < 0.0001). Conclusion:Elastic stable intramedullary nailing is a minimally invasive procedure for long bone fractures in children.It can effectively improve the operation-related indicators and postoperative quality of life and reduce the incidence of complications.

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“…However, it is unknown at patient level how often both an orthopaedic trauma certified surgeon and a geriatrician is available (unknown clinical relevancy) [20]. Treatment by a trauma certified surgeon is associated with fewer reoperations and surgical site infections compared to treatment by a general surgeon (scientifically acceptable-valid) [21].…”

Section: Operation Within 24 Hoursmentioning

confidence: 99%

Textbook process as a composite quality indicator for in-hospital hip fracture care

Voeten

Wouters²,

Würdemann

et al. 2021

Arch Osteoporos

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Summary Individual process indicators often do not enable the benchmarking of hospitals and often lack an association with outcomes of care. The composite hip fracture process indicator, textbook process, might be a tool to detect hospital variation and is associated with better outcomes during hospital stay. Purpose The aim of this study was to determine hospital variation in quality of hip fracture care using a composite process indicator (textbook process) and to evaluate at patient level whether fulfilment of the textbook process indicator was associated with better outcomes during hospital stay. Methods Hip fracture patients aged 70 and older operated in five hospitals between 1 January 2018 and 31 December 2018 were included. Textbook process for hip fracture care was defined as follows: (1) assessment of malnutrition (2) surgery within 24 h, (3) orthogeriatric management during admission and (4) operation by an orthopaedic trauma certified surgeon. Hospital variation analysis was done by computing an observed/expected ratio (O/E ratio) for textbook process at hospital level. The expected ratios were derived from a multivariable logistic regression analysis including all relevant case-mix variables. The association between textbook process compliance and in-hospital complications and prolonged hospital stay was determined at patient level in a multivariable logistic regression model, with correction for patient, treatment and hospital characteristics. In-hospital complications were anaemia, delirium, pneumonia, urinary tract infection, in-hospital fall, heart failure, renal insufficiency, pulmonary embolism, wound infection and pressure ulcer. Results Of the 1371 included patients, 753 (55%) received care according to textbook process. At hospital level, the textbook compliance rates ranged from 38 to 76%. At patient level, textbook process compliance was significantly associated with fewer complications (38% versus 46%) (OR 0.66, 95% CI 0.52–0.84), but not with hospital stay (median length of hospital stay was 5 days in both groups) (OR 1.01, 95% CI 0.78–1.30). Conclusion The textbook process indicator for hip fracture care might be a tool to detect hospital variation. At patient level, this quality indicator is associated with fewer complications during hospital stay.

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Trauma surgery by general surgeons: Still an option for proximal femoral fractures?

Cited by 7 publications

References 7 publications

Variation in treatment of hip fractures and guideline adherence amongst surgeons with different training backgrounds in the Netherlands

Variation in treatment of hip fractures and guideline adherence amongst surgeons with different training backgrounds in the Netherlands

Clinical Efficacy of Minimally Invasive Elastic Stable Intramedullary Nailing for Limb Long Bone Fractures in Children

Textbook process as a composite quality indicator for in-hospital hip fracture care

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