Hip Fractures
Conditions
Keywords
implant positioning, reduction, intraoperative fluoroscopy, reduction algorithm
Brief summary
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.
Detailed description
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.
Interventions
OTHERInstructional video
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).
OTHERReduction algorithm
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.
Sponsors
University Hospital, Basel, Switzerland
Study design
Observational model
COHORT
Time perspective
PROSPECTIVE
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* Patients presenting with an intertrochanteric fracture type 31A1 or 31A2 or subtrochanteric fracture type 31A3 * Surgeon must have completed the teaching video on how to evaluate intraoperatively the fracture, the reduction and the implant positioning and complete the reduction algorithm documenting that all intraoperative steps have been correctly accomplished
Exclusion criteria
* Patients operated without adherence to the reduction algorithm * Patients operated by surgeons who did not attend the teaching session
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Shortening of the femoral neck (mm) | 6 months after hip surgery | Radiologic result: Shortening of the femoral neck as measured with sliding of the femoral neck screw inside the nail |
| Change of the shaft-neck angle (degree) | 6 months after hip surgery | Radiologic result: Change of the shaft-neck angle on the antero-posterior view in comparison to postoperative value |
| Displacement of the calcar segment in the lateral view | 6 months after hip surgery | Radiologic result: Displacement of the calcar segment in the lateral view |
| Central placement of the femoral neck screw (degree) | 6 months after hip surgery | Radiologic result: Central placement of the femoral neck screw as measured with the Tip-Apex-Distance |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Hip re-operations | 6 months after hip surgery | Number of re-operations due to loss of reduction |
| Reduction of the calcar segment in the lateral view (mm) | second postoperative day | Radiologic result: Reduction of the calcar segment in the lateral view |
| Mortality | 6 months after hip surgery | Number of patients that have died |
| Operation time from incision until closure of the wound (minutes) | second postoperative day | Operation time from incision until closure of the wound |
| Central placement of the femoral neck screw (degree) | second postoperative day | Radiologic result: Central placement of the femoral neck screw as measured with the Tip-Apex-Distance |
Countries
Switzerland
Outcome results
None listed