TY - JOUR
T1 - Intramedullary nailing versus sliding hip screw for A1 and A2 trochanteric hip fractures
T2 - WHAT FACTORS INFLUENCE SURGEONS' CHOICE OF IMPLANT?
AU - Ankleplatform Study Collaborative - Science of Variation Group
AU - Mellema, J. J.
AU - Janssen, S.
AU - Schouten, T.
AU - Haverkamp, D.
AU - van den Bekerom, M. P.J.
AU - Ring, D.
AU - Doornberg, J. N.
AU - Babis, George
AU - Gillespie, James A.
AU - McLaurin, Toni M.
AU - Giordano, Vincenzo
AU - Marsh, J.
AU - Eng, Kevin
AU - Krause, Peter
AU - Moreta-Suarez, Jesus
AU - Brink, Ole
AU - Barquet, Antonio
AU - Roiz, Juan Miguel Rodríguez
AU - van der Heide, Huub
AU - Brilej, Drago
AU - Smith, Raymond Malcolm
AU - Jubel, Axel
AU - Haverlag, R.
AU - Harris, Ian
AU - Havliček, Tomo
AU - Conflitti, Joseph M.
AU - Pountos, Ippokratis
AU - Higgins, Thomas
AU - Zuurmond, R. G.
AU - Mittlmeier, Thomas
AU - Tyllianakis, Minos
AU - Dickson, Kyle
AU - Leslie, Michael P.
AU - Dias Belangero, William
AU - Chauhan, Aakash
AU - Swiontkowski, Marc
AU - Babst, Reto H.
AU - Morgan, Steven J.
AU - Appleton, Paul
AU - Klostermann, Cyrus
AU - Borris, Lars C.
AU - Schulte, Leah M.
AU - Satora, Wojciech
AU - Althausen, Peter
AU - Schandelmaier, Peter
AU - Peters, A.
AU - Gadbled, Guillaume
AU - Tosounidis, Theodoros
AU - Meylaerts, S. A.
AU - Morrey, Christopher N.
N1 - Funding Information:
No benefits in any form have been received or will be received from a commercial party related directly or indirectly to the subject of this article. European Federation of National Associations of Orthopaedics and Traumatology Task Force
Publisher Copyright:
© 2021 The British Editorial Society of Bone & Joint Surgery
PY - 2021/4
Y1 - 2021/4
N2 - Aims This study evaluated variation in the surgical treatment of stable (a1) and unstable (a2) trochanteric hip fractures among an international group of orthopaedic surgeons, and determined the influence of patient, fracture, and surgeon characteristics on choice of implant (intramedullary nailing (ImN) versus sliding hip screw (SHS)). methods a total of 128 orthopaedic surgeons in the Science of Variation Group evaluated radiographs of 30 patients with Type a1 and a2 trochanteric hip fractures and indicated their preferred treatment: ImN or SHS. The management of Type a3 (reverse obliquity) trochanteric fractures was not evaluated. agreement between surgeons was calculated using multirater kappa. multivariate logistic regression models were used to assess whether patient, fracture, and surgeon characteristics were independently associated with choice of implant. results The overall agreement between surgeons on implant choice was fair (kappa = 0.27 (95% confidence interval (CI) 0.25 to 0.28)). Factors associated with preference for IMN included USA compared to Europe or the UK (Europe odds ratio (OR) 0.56 (95% CI 0.47 to 0.67); UK OR 0.16 (95% CI 0.12 to 0.22); p < 0.001); exposure to IMN only during training compared to surgeons that were exposed to both (only IMN during training OR 2.6 (95% CI 2.0 to 3.4); p < 0.001); and A2 compared to A1 fractures (Type A2 OR 10 (95% CI 8.4 to 12); p < 0.001). Conclusion In an international cohort of orthopaedic surgeons, there was a large variation in implant preference for patients with a1 and a2 trochanteric fractures. This is due to surgeon bias (country of practice and aspects of training). The observation that surgeons favoured the more expensive implant (IMN) in the absence of convincing evidence of its superiority suggests that surgeon de-biasing strategies may be a useful focus for optimizing patient outcomes and promoting value-based healthcare.
AB - Aims This study evaluated variation in the surgical treatment of stable (a1) and unstable (a2) trochanteric hip fractures among an international group of orthopaedic surgeons, and determined the influence of patient, fracture, and surgeon characteristics on choice of implant (intramedullary nailing (ImN) versus sliding hip screw (SHS)). methods a total of 128 orthopaedic surgeons in the Science of Variation Group evaluated radiographs of 30 patients with Type a1 and a2 trochanteric hip fractures and indicated their preferred treatment: ImN or SHS. The management of Type a3 (reverse obliquity) trochanteric fractures was not evaluated. agreement between surgeons was calculated using multirater kappa. multivariate logistic regression models were used to assess whether patient, fracture, and surgeon characteristics were independently associated with choice of implant. results The overall agreement between surgeons on implant choice was fair (kappa = 0.27 (95% confidence interval (CI) 0.25 to 0.28)). Factors associated with preference for IMN included USA compared to Europe or the UK (Europe odds ratio (OR) 0.56 (95% CI 0.47 to 0.67); UK OR 0.16 (95% CI 0.12 to 0.22); p < 0.001); exposure to IMN only during training compared to surgeons that were exposed to both (only IMN during training OR 2.6 (95% CI 2.0 to 3.4); p < 0.001); and A2 compared to A1 fractures (Type A2 OR 10 (95% CI 8.4 to 12); p < 0.001). Conclusion In an international cohort of orthopaedic surgeons, there was a large variation in implant preference for patients with a1 and a2 trochanteric fractures. This is due to surgeon bias (country of practice and aspects of training). The observation that surgeons favoured the more expensive implant (IMN) in the absence of convincing evidence of its superiority suggests that surgeon de-biasing strategies may be a useful focus for optimizing patient outcomes and promoting value-based healthcare.
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U2 - 10.1302/0301-620X.103B.BJJ-2020-1490.R1
DO - 10.1302/0301-620X.103B.BJJ-2020-1490.R1
M3 - Article
C2 - 33591214
AN - SCOPUS:85103683655
SN - 2049-4394
VL - 103 B
SP - 775
EP - 781
JO - Bone and Joint Journal
JF - Bone and Joint Journal
IS - 4
ER -