Subspecialty Fellowship Training Is Not Associated with Better Outcomes in Fixation of Low-Energy Femoral Neck Fractures - An Analysis of the Fixation Using Alternative Implants for the Treatment of Hip Fractures Database

Objectives:To compare risk of reoperation for femoral neck fracture patients undergoing fixation with cancellous screws (CSs) or sliding hip screws based on surgeon fellowship (trauma-fellowship-trained vs. non-trauma-fellowship-trained).Design:Retrospective review of Fixation using Alternative Implants for the Treatment of Hip fractures data.Setting:Eighty-one centers across 8 countries.Patients/Participants:Eight hundred nineteen patients ≥50 years old with low-energy hip fractures requiring surgical fixation.Intervention:Patients were randomized to CS or sliding hip screw group in the initial dataset.Main Outcome Measurements:The primary outcome was risk of reoperation. Secondary outcomes included death, serious adverse events, radiographic healing, discharge disposition, and use of ambulatory devices postoperatively.Results:There was no difference in risk of reoperation between the 2 surgeon groups (P > 0.05). Patients treated by orthopaedic trauma surgeons were more likely to be overweight/obese and have major medical comorbidities (P < 0.05). There was a higher risk of serious adverse events, higher likelihood of radiographic healing, and higher odds of discharge to a facility for patients treated by trauma-fellowship-trained surgeons (P < 0.05).Conclusions:Based on these data, risk of reoperation for low-energy femoral neck fracture fixation is equivalent regardless of fellowship training. The higher likelihood of radiographic healing noted in the trauma-trained group does not seem to have a major clinical implication because it did not affect risk of reoperation between the 2 groups. Patient-specific factors present preinjury, such as body habitus and medical comorbidities, may account for the lower odds of discharge to home and higher risk of postoperative medical complications for patients treated by orthopaedic trauma surgeons.Level of Evidence:Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.