Orthopedic Surgery Resident Exposure to Sliding Hip Screw Fixation for Intertrochanteric Femur Fractures: A...

Area of Science:

• Orthopedic Surgery
• Trauma Surgery
• Surgical Education

Background:

• Intertrochanteric femur fractures are common injuries requiring surgical fixation.
• Sliding hip screws (SHS) and intramedullary nails (IMN) are common fixation methods.
• Orthopedic residents' exposure to different fixation techniques during training is crucial for developing surgical skills.

Purpose of the Study:

• To evaluate the exposure of orthopedic surgery residents to sliding hip screws (SHS) versus intramedullary nail (IMN) fixation for intertrochanteric femur fractures.
• To identify trends in the utilization of SHS and IMN by residents over a five-year period.
• To compare SHS usage rates across different hospital settings.

Main Methods:

• Retrospective analysis of 5,910 intertrochanteric femur fracture cases treated by residents from 2017-2021.
• Data sourced from ACGME case logs using CPT codes for SHS (27244) and IMN (27245).
• Multivariate logistic binary regression used to compare SHS usage rates by year and hospital type (trauma, non-trauma, VA).

Main Results:

• Intramedullary nail fixation was used in 88.8% of cases.
• Sliding hip screw utilization decreased from 15.6% in 2017 to 9.2% in 2021 (p < 0.001).
• SHS usage was lowest in non-trauma centers (5.4%) and highest in level one trauma centers (11.7%).

Conclusions:

• Orthopedic residents have limited exposure to SHS compared to IMN.
• A significant trend towards decreased SHS use in residency training was observed.
• This declining experience may contribute to the preference for IMN and risks making SHS a "lost art."