Optimising reduction and implant positioning in intertrochanteric fracture treatment: An evaluation of the effects of a structured educational program.

Introduction: Intertrochanteric fractures are common in older adults and pose significant challenges in terms of morbidity and mortality. Accurate reduction and optimal implant positioning during operative stabilisation of these fractures reduce the rates of complications and reoperations while improving functional outcomes in this population. This study aimed to assess the effects of a structured educational intervention on the radiographic outcomes, reduction quality, and revision rates of intertrochanteric fractures.

Methods: We initiated a training program that included an instructional video on interpreting intraoperative fluoroscopic views, as well as instructions and an algorithm for reducing and stabilising intertrochanteric fractures and mandated its implementation for all operating surgeons. We thus established an intervention cohort (n = 209) of patients who underwent surgery after the program's introduction, which we compared with a historical control cohort (n = 207) of patients who had undergone surgery before the program's implementation. The analysed postoperative radiographic parameters included the Baumgaertner reduction index, tip-apex distance (TAD), restoration of the caput-collum-diaphyseal angle, and calcar displacement. Mortality and the need for revision surgery were monitored for 2 years postoperatively.

Results: We observed significant improvements in the intervention cohort, particularly among the less experienced surgeons. The TAD was reduced by 7 %, indicating improved implant positioning. Similarly, the Baumgaertner reduction index revealed an increase in 'good' reductions (40.2% vs. 37.2 %). Additionally, the rates of revision surgery (4.8% vs. 11.1 %) and mechanical complications (1.9% vs. 6.3 %) were lower in the intervention cohort than in the control cohort.

Conclusion: Implementation of the structured training program led to better radiographic outcomes for intertrochanteric fractures, especially among less experienced surgeons. The observed improvements in reduction quality and decrease in revision rates underscore the potential benefits of incorporating educational interventions in orthopaedic trauma treatment.