Management of elderly hip fractures by an orthopaedic trauma surgeon reduces surgical delays but does not improve outcomes compared to non-trauma surgeons.

Abstract

Recent literature on hip fractures has focussed on the optimal environment for best outcomes. One factor that has not been studied is the managing surgeon's training background. Our study aims to examine if hip fracture patients managed by fellowship-trained orthopaedic trauma surgeons have better outcomes compared to non-trauma trained general orthopaedic surgeons. This is a retrospective study performed at a tertiary hospital with an established orthogeriatric co-managed hip fracture care pathway. All surgically treated elderly hip fracture patients over a period of 2years were included and divided into 2 groups based on the managing surgeon: trauma and non-trauma. Patient characteristics, fracture and surgery information, post-operative complications, 1year mortality and the Modified Barthel Index (MBI) scores were collected and compared. 871 patients were included. 32.1% (N = 280) were managed by trauma surgeons and 67.9% (N = 591) by non-trauma surgeons. There was no significant difference in the MBI scores pre-operatively and at 6 and 12 months post-operatively between the 2 groups. There was no difference in the incidence of postoperative complications and mortality. However, patients managed by trauma surgeons had significantly shorter time to surgery (p = 0.028) and higher proportion of surgeries performed within 48h (p = 0.039). Trauma surgeons also took a shorter time to fix intertrochanteric fractures (p = 0.000). This study did not find any difference in the functional outcomes of hip fracture patients managed by trauma surgeons or non-trauma surgeons. However, trauma surgeons had faster times to surgery and shorter surgical times when fixing intertrochanteric fractures.