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Learning curves in hip fracture surgery

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Abstract

The aim of this study was to identify and characterise learning curves in hip fracture surgery. Operating times were collected and related to the number of procedures done by residents performing closed reduction and internal fixation using cannulated screws for intracapsular fractures of the hip and cephalomedullary nailing for trochanteric fractures, as well as hemiarthroplasty for displaced intracapsular fractures. The mean operating times decreased significantly for all four procedures studied, though at different rates. For cannulated screws, the mean duration of surgery decreased from 47.8 minutes to 30.1 minutes for procedures 21–25. For cephalomedullary nailing without distal locking, the mean operating time decreased from 73.3 minutes to 36.3 minutes. For cephalomedullary nailing with distal locking, the mean operating time decreased from 81.7 minutes to 56.9 minutes. The mean operating time for hemiarthroplasty decreased from 97.3 minutes to 66.0 minutes. Mean operating times decreased significantly for all procedures studied, though at different rates, indicating a unique learning curve for each procedure.

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References

  1. Delaunay C, Kapandji AI (1998) 10-year survival of Zweymuller total prostheses in primary uncemented arthroplasty of the hip. Rev Chir Orthop Reparatrice Appar Mot 84:421–432

    PubMed  CAS  Google Scholar 

  2. Paillard P (2007) Hip replacement by a minimal anterior approach. Int Orthop 31(Suppl 1):S13–S15

    Article  PubMed  Google Scholar 

  3. Swanson TV (2007) Posterior single-incision approach to minimally invasive total hip arthroplasty. Int Orthop 31(Suppl 1):S1–S5

    Article  PubMed  Google Scholar 

  4. Pardiwala D, Prabhu V, Dudhniwala G, Katre R (2001) The AO distal locking aiming device: an evaluation of efficacy and learning curve. Injury 32:713–718

    Article  PubMed  CAS  Google Scholar 

  5. De VJ, Vandenberghe D (2003) Acute percutaneous scaphoid fixation using a non-cannulated Herbert screw. Chir Main 22:78–83

    Article  Google Scholar 

  6. Rosenkranz J, Babst R (2006) A special instrument: the LISS tractor. Oper Orthop Traumatol 18:88–99

    Article  PubMed  Google Scholar 

  7. Jain NP, Jowett AJ, Clarke NM (2007) Learning curves in orthopaedic surgery: a case for super-specialisation? Ann R Coll Surg Engl 89:143–146

    Article  PubMed  CAS  Google Scholar 

  8. Hansen TB, Snerum L (2008) Elektra trapeziometacarpal prosthesis for treatment of osteoarthrosis of the basal joint of the thumb. Scand J Plast Reconstr Surg Hand Surg 42:316–319

    Article  PubMed  Google Scholar 

  9. Cook JA, Ramsay CR, Fayers P (2004) Statistical evaluation of learning curve effects in surgical trials. Clin Trials 1:421–427

    Article  PubMed  Google Scholar 

  10. Ramsay CR, Grant AM, Wallace SA, Garthwaite PH, Monk AF, Russell IT (2001) Statistical assessment of the learning curves of health technologies. Health Technol Assess 5:1–79

    PubMed  CAS  Google Scholar 

  11. Wiese M, Kramer J, Bernsmann K, Ernst WR (2004) The related outcome and complication rate in primary lumbar microscopic disc surgery depending on the surgeon’s experience: comparative studies. Spine J 4:550–556

    Article  PubMed  Google Scholar 

  12. Callaghan JJ, Heekin RD, Savory CG, Dysart SH, Hopkinson WJ (1992) Evaluation of the learning curve associated with uncemented primary porous-coated anatomic total hip arthroplasty. Clin Orthop Relat Res 132–144

  13. Heller JG, Carlson GD, Abitbol JJ, Garfin SR (1991) Anatomic comparison of the Roy-Camille and Magerl techniques for screw placement in the lower cervical spine. Spine 16:S552–S557

    Article  PubMed  CAS  Google Scholar 

  14. Minekus JP, Rozing PM, Valstar ER, Dankelman J (2003) Evaluation of humeral head replacements using time-action analysis. J Shoulder Elbow Surg 12:152–157

    Article  PubMed  Google Scholar 

  15. Gross M (1993) Innovations in surgery. A proposal for phased clinical trials. J Bone Joint Surg Br 75:351–354

    PubMed  CAS  Google Scholar 

  16. Cobb JP, Kannan V, Brust K, Thevendran G (2007) Navigation reduces the learning curve in resurfacing total hip arthroplasty. Clin Orthop Relat Res 463:90–97

    PubMed  Google Scholar 

  17. Devereaux PJ, Bhandari M, Clarke M, Montori VM, Cook DJ, Yusuf S, Sackett DL, Cinà CS, Walter SD, Haynes B, Schünemann HJ, Norman GR, Guyatt GH (2005) Need for expertise based randomised trials. Br Med J 330:88–93

    Article  CAS  Google Scholar 

  18. Weatherby BA, Rudd JN, Ervin TB, Stafford PR, Norris BL (2007) The effect of resident work hour regulations on orthopaedic surgical education. J Surg Orthop Adv 16:19–22

    PubMed  Google Scholar 

  19. Goldhagen PR, O’Connor DR, Schwarze D, Schwartz E (1994) A prospective comparative study of the compression hip screw and the gamma nail. J Orthop Trauma 8:367–372

    Article  PubMed  CAS  Google Scholar 

  20. Hardinge K (1982) The direct lateral approach to the hip. J Bone Joint Surg Br 64:17–19

    PubMed  CAS  Google Scholar 

  21. Minekus JP, Rozing PM, Nelissen R, Dankelman J (2005) Identifying error pathways during elbow and knee replacements. Clin Orthop Relat Res 121–127

  22. Shervin N, Rubash HE, Katz JN (2007) Orthopaedic procedure volume and patient outcomes: a systematic literature review. Clin Orthop Relat Res 457:35–41

    Article  PubMed  Google Scholar 

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Correspondence to Kristian Bjorgul.

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Level of evidence: Level II, prognostic study

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Bjorgul, K., Novicoff, W.M. & Saleh, K.J. Learning curves in hip fracture surgery. International Orthopaedics (SICOT) 35, 113–119 (2011). https://doi.org/10.1007/s00264-010-0950-7

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  • DOI: https://doi.org/10.1007/s00264-010-0950-7

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