Influence de l’expertise du chirurgien et du type de fracture sur les résultats cliniques d’ostéosynthèse mini-invasive de fractures du radius distal

Abstract

Introduction: In orthopedic surgery, the quality of the clinical outcome depends on many factors: surgeon experience, patient comorbidities, complexity of the pathology and influence of the approach.Objectives: The aim of this study was to investigate the influence of the surgeon's level of expertise and/or fracture complexity on the clinical outcome of minimally invasive osteosynthesis of distal radius fractures (MIPO).Methods: The series included 94 AO type A or C fractures classified according to the surgeons' level of expertise, measured from I (beginner) to V (expert). There were 2 level III surgeons, 3 level IV surgeons and 3 level V surgeons. Clinical results were assessed at 8 weeks using the Mayo Modified Wrist Score (MMWS) (0-64 poor, 65-79 fair, 80-89 good, 90-100 excellent).Results: The median MMWS was 57.5 (poor) for level III, 58.5 (poor) for level IV and 68 (average result) for level V. The median MMWS was 60 for type A fractures and 59 for type C. The median MMWS was 60 for simple fractures (A+C1) and 57 for complex fractures (C2+C3).MMWS did not change between levels III and IV. Level V had better results than levels III and IV, with no difference between simple and complex fractures. Levels III and IV had poorer results with complex fractures.Discussion: MMWS increased with surgeon level of expertise after MIPO. MMWS decreased with fracture complexity for surgeons with level III and IV expertise. While it is not possible to modify fracture complexity, it is possible to improve surgeon expertise and performance.Conclusion: The surgeon's expertise and/or the complexity of the fracture play a role in the clinical outcome after MIPO.Level of proof: III