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. 2011 Jan;35(1):113-9.
doi: 10.1007/s00264-010-0950-7. Epub 2010 Feb 20.

Learning curves in hip fracture surgery

Kristian Bjorgul  1 , Wendy M Novicoff, Khaled J Saleh
Affiliations

Learning curves in hip fracture surgery

Kristian Bjorgul et al. Int Orthop. 2011 Jan.

Abstract

The aim of this study was to identify and characterise learning curves in hip fracture surgery. Operating times were collected and related to the number of procedures done by residents performing closed reduction and internal fixation using cannulated screws for intracapsular fractures of the hip and cephalomedullary nailing for trochanteric fractures, as well as hemiarthroplasty for displaced intracapsular fractures. The mean operating times decreased significantly for all four procedures studied, though at different rates. For cannulated screws, the mean duration of surgery decreased from 47.8 minutes to 30.1 minutes for procedures 21-25. For cephalomedullary nailing without distal locking, the mean operating time decreased from 73.3 minutes to 36.3 minutes. For cephalomedullary nailing with distal locking, the mean operating time decreased from 81.7 minutes to 56.9 minutes. The mean operating time for hemiarthroplasty decreased from 97.3 minutes to 66.0 minutes. Mean operating times decreased significantly for all procedures studied, though at different rates, indicating a unique learning curve for each procedure.

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Figures

Fig. 1
Fig. 1
Mean operating times for all residents for each procedure. The procedures are grouped into clusters of five procedures according to the order in which they were undertaken, with the values on the x-axes corresponding to five procedures. Operating times are on the y-axis. Vertical bars represent 95% confidence intervals of mean. Non-overlapping bars indicate statistically significant differences between groups. a Internal fixation with cannulated screws. b Closed reduction and intramedullary nailing without distal locking. c Closed reduction and intramedullary nailing with distal locking. d Hemiarthroplasty performed by residents. e Hemiarthroplasty performed by orthopaedic surgeons
Fig. 2
Fig. 2
Duration of surgery for one resident (resident 9) performing cannulated screws who did not improve mean operating times during the series of procedures
Fig. 3
Fig. 3
Duration of surgery for one resident (resident 10) performing cannulated screws who improved mean operating times during the series of procedures
See this image and copyright information in PMC

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