Abstract
BackgroundIntertrochanteric femoral fractures are prevalent among the elderly, and usually demands surgical treatments. Proximal femoral nail antirotation Asian version (PFNA-II) is widely used for intertrochanteric fracture treatment. The computer-assisted preoperative planning (CAPP) system has the potential to reduce the difficulty of PFNA-II in the treatment of intertrochanteric fractures. The aim of the study was to investigate and compare the learning curves of PFNA-II treatment with CAPP and conventional preoperational planning methods for intertrochanteric femoral fractures.MethodsA total of 125 patients with intertrochanteric fracture who were treated with PFNA-II between March 2012 and June 2015 were retrospectively analyzed. Patients who underwent surgery with CAPP procedure by a junior surgeon were regarded as group A (n = 53); patients who underwent the conventional surgery by another junior surgeon were regarded as group B (n = 72). Each group was divided into three subgroups (case 1–20, case 21–40, case 41–53 or case 41–72).ResultsThe average operation time of group A was 45.00(42.00, 50.00) minutes, and in group B was 55.00 (50.00, 60.00) minutes (P < 0.01). Average radiation frequency and blood loss were 13.02 ± 2.32, 160.00 (140.00, 170.00) ml and 20.92 ± 3.27, 250.00 (195.00, 279.50) ml, respectively, with significant differences (P < 0.01). The learning curve of the surgical procedure in group A was steeper than that in group B. There were no significant differences in patient reported outcomes, hospital stay and complication rate between the two groups. Significant differences were observed between group A and B in Harris score at last follow-up in the AO/OTA type 31-A2 intertrochanteric fracture (P < 0.05).ConclusionCompared with conventional preoperative planning methods, CAPP system significantly reduced operation time, radiation frequency and blood loss, thus reshaped the learning curve of PFNA-II treatment with lower learning difficulty.Trial registrationresearchregistry4770. Registered 25 March 2019.
Highlights
Intertrochanteric femoral fractures are prevalent among the elderly, and usually demands surgical treatments
The preoperative planning and evaluation in group A were conducted with the assistance of the computer-assisted preoperative planning (CAPP) system, whereas only conventional preoperative planning was conducted in group B
There exist no significant differences in gender, age, fracture sides, AO Foundation/Orthopaedic Trauma Association (AO/OTA) classification, comorbidities and hospital stay time
Summary
Intertrochanteric femoral fractures are prevalent among the elderly, and usually demands surgical treatments. The aim of the study was to investigate and compare the learning curves of PFNA-II treatment with CAPP and conventional preoperational planning methods for intertrochanteric femoral fractures. Intertrochanteric femoral fractures are the second most common type of hip fractures, and remain a major challenge for orthopaedic surgeons worldwide [1]. These fractures are usually classified as stable or unstable, with unstable fractures being more common [2]. A previous study revealed that the primary cause of high mortality and complication rates in patients with an intertrochanteric femoral fracture is lack of exercise and long-term bed rest [7]. Mobilization and full weight bearing as soon as possible are important after surgery [10]
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