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

This study aimed to determine the level of exposure to sliding hip screws amongst orthopedic surgery residents compared to intramedullary nail fixation for intertrochanteric femur fractures.

Data was collected from five orthopedic surgery residency programs through the case log system of the accreditation council for graduate medical education (ACGME) based on current procedural terminology codes (CPT). The rates of IMN for treatment of IT fracture (27245) were compared to SHS fixation (27244) for the period of 2017-2021. The location of the procedure was also logged as either a level one trauma center, non-trauma hospitals, and a veteran's affairs hospital (VA). Rates of SHS usage were compared by year and location type using multivariate logistic binary regression.

5,910 IT femur fractures were treated by orthopedic residents during the time period. IMN was utilized for 88.8% of cases. The highest usage of SHS was 15.6% in 2017 with a statistically significant decrease to 9.2% in 2021 (p < 0.001). SHS utilization was lowest at non-trauma centers (5.4%) and highest at level one trauma centers (11.7%).

Residents get limited experience with SHS compared to IMN in their training programs, and there is a significant trend toward fewer SHS implants being used by residents over the past 5 years. Residents' limited experience with SHS during residency may contribute for the trend toward IMN use. Surgeons at academic institutions ought to recognize this trend and strongly consider their implant choice when treating intertrochanteric femur fractures for fear of sliding hip screws becoming a lost art. Level of Evidence: IV.