The learning curve of proximal femoral nailing

The aim of this study was to evaluate operation time and surgical complication rate of proximal femoral nailing during resident training.

This retrospective evaluation included 659 patients (508 females, 151 males; mean age: 80.7 years), operated by 63 supervised residents between 1998 and 2010. All patients received the same implant (Targon® PF). Fracture classification, operation time and early surgical complications causing reoperation or hospital readmission (i.e. hematoma, infection, hip perforation, nonunion, implant malpositioning) were recorded and correlated with the resident's operative experience measured by the number of operations performed.

Mean operation time was 61.3 (range: 59.8 to 62.8) minutes. Mean operation time of a resident's first 15 training operations was 8.7 minutes longer than that of later operations (p<0.001). No further significant shortening of operation time was experienced after the first 15 training operations. Overall surgical complication rate was 9.3% (range: 7.0% to 11.5%). There were no significant differences in complication rate (9.9% vs. 8.2%; p=0.47), hematoma formation (2.5% vs. 0.8%; p=0.07), infection (2.7% vs. 3.9%; p=0.52), nonunion (0.7% vs. 1.6%; p=0.51), cut-out (1.2% vs. 2.4%; p=0.31), lag screw perforation (3.2% vs. 0.4%; p=0.07) or implant malpositioning (0.5% vs. 0.0%; p=0.26) between the first 10 and subsequent training operations the subsequent training operations.

After 15 training operations, a resident's operative speed did not significantly differ from that of more experienced collegues. Early surgical complications were not significantly affected by the resident's experience.