Complex fractures, do we operate on enough to gain and maintain experience?

Area of Science:

• Orthopaedic Surgery
• Trauma Management
• Surgical Education

Background:

• Complex fractures necessitate advanced surgical skills and continuous practice for optimal outcomes.
• The frequency of complex fracture treatment impacts both patient care quality and specialist registrar training.

Purpose of the Study:

• To audit the incidence of complex fracture treatment by individual orthopaedic consultants.
• To assess the implications of fracture treatment volume on surgical expertise and training.

Main Methods:

• Defined complex fractures as comminuted, peri- or intra-articular, or segmental shaft fractures (AO groups B and C).
• Reviewed theatre records and radiographs from three hospitals (two DGHs, one University Hospital) over 6-12 months.
• Documented the number and types of complex fractures treated by individual consultants.

Main Results:

• Individual consultants treated a low volume of complex fractures, with some managing none or only one or two.
• Treatment volumes varied significantly, with some specialists focusing on specific regions treating up to 25 cases.
• Complex fractures were found to be infrequent at the individual hospital and surgeon level.

Conclusions:

• The infrequent presentation of complex fractures challenges the maintenance of surgical expertise.
• Consideration should be given to increasing cross-referrals to surgeons with specialized interests in trauma or specific anatomical regions.
• Optimizing complex fracture management may require a shift towards more centralized care or enhanced collaborative referral networks.