Trochanteric Fractures - How to Improve the Results of Reduction and Implant Positioning

Study Overview
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Brief Summary
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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
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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.

Official Title
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Structured Educational Program and the Use of a Practical Algorithm for Reduction and Stabilisation of Trochanteric Fractures With in Intramedullary Nail Improved Radiologic Reduction and Implant Positioning. A Prospective Study With 6 Months Follow-up.

Conditions
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Hip Fractures

Intervention / Treatment
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* Other: Instructional video
* Other: Reduction algorithm


Participation Criteria
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Eligibility Criteria
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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

Ages Eligible for Study
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Minimum Age: 18 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Arms and Interventions

| Intervention/Treatment |
| --- |
|Other: Instructional 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).|
|Other: Reduction 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.|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Shortening of the femoral neck (mm) | Radiologic result: Shortening of the femoral neck as measured with sliding of the femoral neck screw inside the nail | 6 months after hip surgery | 
| Change of the shaft-neck angle (degree) | Radiologic result: Change of the shaft-neck angle on the antero-posterior view in comparison to postoperative value | 6 months after hip surgery | 
| Displacement of the calcar segment in the lateral view | Radiologic result: Displacement of the calcar segment in the lateral view | 6 months after hip surgery | 
| Central placement of the femoral neck screw (degree) | Radiologic result: Central placement of the femoral neck screw as measured with the Tip-Apex-Distance | 6 months after hip surgery | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Hip re-operations | Number of re-operations due to loss of reduction | 6 months after hip surgery | 
| Mortality | Number of patients that have died | 6 months after hip surgery | 
| Operation time from incision until closure of the wound (minutes) | Operation time from incision until closure of the wound | second postoperative day | 
| Central placement of the femoral neck screw (degree) | Radiologic result: Central placement of the femoral neck screw as measured with the Tip-Apex-Distance | second postoperative day | 
| Reduction of the calcar segment in the lateral view (mm) | Radiologic result: Reduction of the calcar segment in the lateral view | second postoperative day | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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implant positioning, reduction, intraoperative fluoroscopy, reduction algorithm