Survey Of Orthopaedic Surgeons Research Articles

Non-surgical treatment of ankle sprains: a survey of orthopedic surgeons in Minas Gerais

Introdução: A entorse de tornozelo é uma lesão comum na população geral e, principalmente, em atletas. O diagnóstico e tratamento adequados permitem o retorno precoce às atividades habituais, evitando recorrência, instabilidade crônica e artrose pós-traumática. O objetivo deste trabalho é avaliar a abordagem diagnóstica e terapêutica desta lesão por ortopedistas do estado de Minas Gerais. Métodos: Esse trabalho foi conduzido pela Comissão Científica da Sociedade Brasileira de Ortopedia e Traumatologia-SBOT/MG em 2023. Foi criado um questionário na plataforma Google Forms com perguntas sobre a abordagem não cirúrgica da entorse de tornozelo. Esse questionário foi distribuído por e-mail e WhatsApp aos membros titulares da SBOT de Minas Gerais. Resultados: 116 ortopedistas responderam ao questionário, sendo 27,6% especialistas em pé e tornozelo. A maioria trabalha em Belo Horizonte e realiza entre 10 e 30 atendimentos relacionados à entorse de tornozelo por mês. A maior parte dos profissionais solicita radiografias e prescreve anti-inflamatórios. A maior divergência de respostas ocorreu quanto ao uso de imobilização. O encaminhamento para tratamento fisioterapêutico variou com o grau da lesão. Discussão: Os dados coletados apontam que a abordagem inicial nas entorses de tornozelo é heterogênea, porém a maioria utiliza protocolos de reabilitação convencionais, apesar da abordagem funcional ser preconizada pela literatura científica. Conclusão: Em Minas Gerais, o protocolo convencional de imobilização e reabilitação é utilizado com maior frequência.

Distal biceps tendon injuries treatment: A survey of orthopaedic surgeons’ current practice and preferences

Purpose Distal biceps tendon (DBT) injuries are relatively uncommon. Controversies exist regarding the best approach, leading to variations in treatment. This study aims to understand the preferences and practices of orthopedic surgeons regarding management of DBT injuries, as well as assess the feasibility of a future pilot randomized controlled trial (RCT) to evaluate the impact of various surgical factors on patient outcomes. Methods A cross-sectional international survey was conducted amongst surgeons treating patients with DBT injuries. The survey included questions about treatment preferences, surgical techniques, case volumes, and interest in participating in a future RCT. Results Responses from 491 orthopedic surgeons from 26 countries/territories were obtained. Most surgeons had limited exposure to DBT ruptures. Variations were observed in the work-up process, with some relying solely on clinical examinations while others used diagnostic imaging. A single incision approach was the most common surgical technique, and tendon fixation with suspensory cortical buttons was frequently preferred. Most surgeons did not explore or repair the bicipital aponeurosis. Interest in participating in a future RCT varied for different surgical controversies. Conclusion This survey provides valuable insights into surgeons’ preferences and practices for DBT injury management. The study highlights the need for standardization in the work-up process and the use of evidence-based guidelines. Current practices may be influenced by factors such as training, implant availability, and costs. The survey also identified surgeons and centers interested in collaboration for future multicenter trials, allowing for equitable access to surgical collaboration opportunities and addressing the lack of evidence in DBT rupture treatment. Level of Evidence Level V, expert-opinion.

Total hip arthroplasty for displaced femoral neck fracture: Survey of orthopaedic surgeons in Ontario, Canada

BackgroundTotal hip arthroplasty (THA) for displaced femoral neck fractures in older patients remains a controversial topic. This study describes patient and surgeon factors that are associated with surgeons’ recommendation of THA for this patient population. Furthermore, this study explores surgeon perceptions on why most patients are treated with hemiarthroplasty over THA. MethodsIn October 2019, a cross-sectional survey was mailed to practicing orthopaedic surgeons in Ontario, Canada. The questionnaire included paper patient cases to capture surgical practice variation using a full factorial, vignette-based experimental design. Multilevel linear regression and multivariable linear regression were used to determine patient and surgeon factors that are associated with treatment recommendations. ResultsOf a target population of 494 practicing surgeons, 302 (61.1%) responded. Sixty percent of respondents worked in the community, and most respondents (89.4%) had fellowship training. Surgeon-level predictors of treatment with THA included higher volume of THA for fracture in the last 12 months, having an elective THA practice, and increasing years in practice. Pre-existing hip arthritis increased likelihood to recommend THA, while increasing patient age and comorbidity burden decreased likelihood to recommend THA. There are medical, institutional, financial, and historic reasons why most patients are treated with hemiarthroplasty over THA. InterpretationThis survey identified several patient and surgeon-level factors that were associated with treatment recommendation for THA. Hemiarthroplasty remains the more common treatment for this patient population for multiple reasons. There is potential for differential access to care when the factors driving treatment decisions are unrelated to the patient.

Proximal Hamstring Tendon Avulsions: A Survey of Orthopaedic Surgeons\u2019 Current Practices in the Nordic Countries

Background and purposeEvidence guiding the decision on whether to treat proximal hamstring tendon avulsions (PHA) operatively or non-operatively is very limited. The aim of this study was to identify the current practices and the rationale behind PHA treatment decisions in the Nordic countries.MethodsA survey was sent to orthopaedic surgeons in Sweden, Norway, Finland and Denmark. The study population consisted of responding surgeons with exposure to surgical treatment of PHA (n = 125). The questions covered surgeon and unit characteristics, and surgeons’ understanding of the evidence for treatment, and they explored which patient and injury factors influence treatment allocation.ResultsAlthough some surgeons indicated a preference for one of the treatments, 84% stated that the treatment decision was based on patient and injury-related factors. Severe obesity, drug abuse, a sedentary lifestyle, age > 60 years and delayed diagnosis (> 6 weeks) were considered contraindications to surgical treatment. Also, there was agreement that patients expressing a preference for non-operative treatment should not be operated. Complete avulsions with tendon dislocation ≥ 2–3 cm on MRI were relative indications for surgical treatment.The majority of surgeons did not believe that operatively treated patients did better than non-operatively treated patients and experienced that patients, generally, were satisfied with the treatment result, regardless of the type of treatment. Most surgeons had experienced significant complications to operative treatment.ConclusionCurrent practices varied among different units, and despite the lack of evidence for their prognostic value, several factors were inconsistently being used as decision modifiers when selecting patients for surgical treatment.

Current practices regarding the management of infrapatellar fat pad during total knee arthroplasty: A survey of orthopedic surgeons

Amaç: Bu çalışmanın amacı Türkiye'deki ortopedi cerrahları arasında primer total diz artroplastisi (TDA) sırasında infrapatellar yağ yastığının (IPFP) yönetimine ilişkin güncel uygulamaları değerlendirmektir.
 Gereç ve Yöntemler: Türkiye Ortopedi ve Travmatoloji Derneği veri tabanına kayıtlı ortopedi cerrahlarına yönelik web tabanlı bir anket Haziran 2020 ile Temmuz 2020 arasında gerçekleştirilmiştir. Anket, IPFP'nin yönetimine ilişkin mevcut uygulamalara ilişkin yedi sorudan oluşmaktadır (IPFP'nin korunması, birincil TDA sırasında kısmi rezeksiyon veya tam rezeksiyon).
 Bulgular: 1553 kayıtlı ortopedi uzmanından 266'sı (% 17) anketi tamamladı. Ortopedi cerrahlarının büyük çoğunluğu (% 75,2) TDA sırasında IPFP'nin yönetimi ile ilgili karar vermelerinin kanıta dayalı olmadığını iddia etti (p

Management of Ankle Fractures With Syndesmotic Disruption: A Survey of Orthopaedic Surgeons.

Introduction: With no current “gold standard” fixation strategy for syndesmotic injuries and differences in preferred preoperative and intraoperative diagnostic techniques and criteria, methods of reduction, fixation constructs, and postoperative management, the goals of this study were to determine how orthopaedic surgeons currently manage ankle fractures with concomitant syndesmotic disruption, as well as to identify surgeon demographics predictive of syndesmotic management techniques.Methods: This study was conducted as a web-based survey of foot and ankle fellowship-trained surgeons, Orthopaedic Trauma Association (OTA) members, and Canadian Orthopaedic Association (COA) members. The survey, sent and completed via the HIPAA-compliant Research Electronic Data Capture (REDCap) system, consisted of 18 questions: 6 surgeon demographic questions and 12 specific syndesmotic management questions regarding perioperative protocols and syndesmotic fixation construct techniques.Results: One hundred and ten orthopaedic surgeons completed our survey. Years of practice and type of fellowship were found to be the variables that influenced perioperative syndesmotic management strategies the most, while a number of fractures operated on per year, country of practice, and practice setting also influenced management decisions. Additionally, 59% (65/110) surgeons indicated that the way they have managed syndesmotic injuries has changed at some point in their career, while 33% (36/110) specified that they could foresee themselves changing their management of these injuries in the future.Conclusions: There was significant variability among responders in preoperative and intraoperative assessment technique, fixation construct, screw removal protocol, and postoperative weightbearing protocol. This study raises awareness of differences in and factors predictive of management strategies and should be used for further discussion when determining a potential gold standard for the management of these complex injuries.

Hip Surveillance for Children with Cerebral Palsy: A Survey of Orthopaedic Surgeons in India.

The purpose of this study was to assess Indian orthopaedic surgeons' current practices and beliefs regarding hip surveillance for children with cerebral palsy (CP), to determine potential support for developing hip surveillance guidelines, and to identify knowledge gaps and key obstacles to guideline implementation in India. An anonymous, cross-sectional online survey was sent to approximately 350 Paediatric Orthopaedic Society of India (POSI) members who were queried on their practices and beliefs about hip surveillance for children with CP, as well as perceived challenges and requirements for the successful implementation of hip surveillance guidelines in the Indian context. Out of 107 responses obtained from POSI members, almost all (96.2%) agreed that hip displacement requires standardized monitoring, using surveillance and surgery to prevent hip dislocation. Approximately half (51.5%) of respondents reported using existing hip surveillance guidelines, with most (41.2%) using the Australian guidelines. Almost all (97%) surgeons indicated that hip surveillance guidelines in India are needed, with 100% expressing interest in following guidelines specific to India. Respondents most frequently indicated late referrals to orthopaedics (81.2%), loss of patients to follow-up (78.2%), and lack of resources (43.6%) as challenges to successful hip surveillance in India. Perceived requirements for implementation included developing Indian-specific guidelines (83.2%) as well as educating surgeons (56.4%), physiotherapists/pediatricians (90.1%), and families (82.2%). Orthopaedic surgeons practicing in India understand the importance of preventing hip dislocations in children with CP through hip surveillance and timely surgical intervention. The results demonstrated strong support for the development of hip surveillance guidelines designed specifically for the Indian healthcare system. The online version contains supplementary material available at 10.1007/s43465-021-00432-3.

Current Surgical Antibiotic Prophylaxis Practices: A Survey of Orthopaedic Surgeons in India.

Surgical antibiotic prophylaxis (SAP) has become the standard of care in orthopaedic surgery. Inappropriate usage of antibiotics (dosage, strength, and/or administration time and duration) can inadvertently result in superadded infections and antimicrobial resistance. The purpose of this study was to document and analyse the prescription patterns for SAP, and to investigate the factors associated with divergence from standard guidelines. We conducted an online cross-sectional questionnaire-based study to collect information about the SAP practices of the members of the Indian Orthopaedic Association (IOA) using Google forms. A link to the questionnaire was sent by e-mails. The overall response rate was 5.73%. While 97.3% respondents practised SAP routinely, the practice was not aligned with standard guidelines' recommendations. There was heterogeneity in the use of SAP in terms of choice of antibiotic(s), number of co-prescribed drugs, single- versus multiple-dose regimens, and the duration of therapy. The prescription practice patterns showed that orthopaedic surgeons almost always used broad-spectrum antibiotics for long durations, regardless of the type of surgery. While Orthopaedic surgeons in India are practicing SAP, the pattern of antibiotic usage is heterogeneous. Variations were noted in the choice of antibiotics for different types of surgeries, time of administration, duration of usage in the postoperative period as well as co-prescriptions. This study highlights the urgent need for a comprehensive, rational, and robust national SAP policy for orthopaedic surgeries.

Management of Ankle Fractures with Syndesmotic Disruption: A Survey of Orthopaedic Surgeons

Category:Ankle; TraumaIntroduction/Purpose:With an increasing frequency of syndesmotic fixation during ankle fracture ORIF and no current gold standard management protocol, it is important for surgeons to understand the frequency and usage patterns of the various techniques among other orthopaedic surgeons. The purposes of this study are to determine how orthopaedic surgeons currently manage ankle fractures with concomitant syndesmotic disruption and to identify surgeon demographics predictive of syndesmotic management.Methods:An 18-question survey, including 10 specific syndesmotic management questions was sent to the Orthopaedic Trauma Association (OTA) and Canadian Orthopaedic Association (COA), as well as sent to email addresses of foot and ankle-fellowship trained surgeons. Surgeon demographic questions included years, country, and type of practice, fellowship(s) completed, setting of ankle fracture surgery, and number of ankle fractures operated on per year. Multinomial regression analysis was performed to determine if surgeon demographics were predictive of syndesmotic management.Results:One-hundred ten orthopaedic surgeons completed our survey. Selected predictors of syndesmotic management included: private practice with academic appointments (0.077 [0.007, 0.834]; p=0.035) being predictive of not using screws through an ORIF plate; foot & ankle fellowship (9.981 [1.787, 55.764]; p=0.009) and trauma fellowship (6.644 [1.302, 33.916]; p=0.023) predictive of utilizing screws through a plate; no fellowship (14.886 [1.226, 180.695]; p=0.034) predictive of only using 1 screw; and surgeons practicing in the U.S. were more likely to not use screws across just 3 cortices (0.031 [0.810, 3.660]; p=0.009). Additionally, among those utilizing suture-button devices, foot & ankle fellowship-trained surgeons were more likely to implement suture-button through plate (7.676 [1.286, 45.806]; p=0.025).Conclusion:Several surgeon factors influence decision making in the management of ankle fractures with syndesmotic disruption. This study raises awareness of differences in management strategies that should be used for further discussion when determining a potential gold standard for management of these complex injuries.

Venous Thromboembolism Prophylaxis After Pelvic and Acetabular Fractures: A Survey of Orthopaedic Surgeons' Current Practices.

The goal of this study was to identify the current practices and rationale of orthopaedic surgeons regarding venous thromboembolism (VTE) prophylaxis for pelvic and acetabular (P&A) fractures. A 25-item web-based questionnaire was made available to all Orthopaedic Trauma Association (OTA) members on the OTA website. Analysis of data was performed after the three-month study period. One hundred three active OTA members completed the survey. Most respondents practiced at an academic level I trauma centers. The most important factor in selecting a VTE regimen was its effectiveness, whereas cost was the least important. Low-molecular-weight heparin (LMWH) remains the preferred agent for VTE prophylaxis after P&A trauma. Factors such as surgical intervention and weight-bearing had a variable effect on surgeons' opinions regarding the type and duration of VTE prophylaxis. Most surgeons treating P&A fractures use LMWH for VTE prophylaxis, but the decision on which agent to use and duration of treatment is multifactorial. Published VTE prophylaxis literature and guidelines provide some guidance, but there is no consensus. Overall, LMWH appears to be the VTE prophylaxis agent of choice for most orthopaedic trauma surgeons, irrespective of nonsurgical or surgical management of these fractures.

Perceptions of using lithium in fracture management: a survey of orthopaedic surgeons, fracture patients and the general public

BackgroundLithium, an established psychiatric medication, has recently been shown to enhance new bone formation in preclinical fracture models. Current research is focused on evaluating the efficacy of low-dose, short-term lithium treatment to improve long bone fracture healing through a Phase II randomized clinical trial (LiFT NCT02999022). In working towards future applications of lithium for fracture management, this study aimed to understand the current perceptions of lithium as a psychiatric drug and the potential barriers to its orthopaedic adoption.MethodsThree questionnaires, evaluating knowledge about lithium and willingness to embrace its use in fracture healing were disseminated among the general population, fracture patients eligible for the LiFT (Lithium for Fracture Treatment) trial and orthopaedic surgeons across Canada.ResultsOf the 768 public respondents, 84% were willing to take a medication that would aid fracture healing but only 62.6% if the medication was lithium. Willingness dropped to 44.6% among the 168 respondents who knew about the psychiatric use of lithium. Lack of sufficient knowledge (n = 50) and concerns about side effects including effects on the brain (n = 74) were the main reasons cited by those who were unwilling to use lithium. Of the 29 fracture patients, only 20 patients had previously heard of lithium. Of these, 40% were willing to take lithium for fracture healing with an additional 10% if the dose was low or if the intake duration was short. Only 50% knew that lithium has side effects. Of the 43 orthopaedic surgeons, 38 surgeons knew about clinical use of lithium. Of these, 68% knew that lithium has side effects and 29% knew that it interacts with other drugs. While most agreed that new strategies are needed to improve fracture management, only 68% were willing to prescribe lithium for fractures with an additional 16% if there is scientific evidence and/or a standard dosing protocol.ConclusionsThis study identified a lack of knowledge about uses and side effects of lithium among all three cohorts. A robust educational framework for orthopaedic surgeons, their patients and the members of their clinical care teams will be essential to widespread repurposing of lithium for fracture care.

Current practice and preferences to management of equinus in children with ambulatory cerebral palsy: A survey of orthopedic surgeons.

Introduction: The consensus among orthopedic surgeons on the management of equinus deformity in cerebral palsy (CP) children has not been reported previously despite being a prevalent deformity. The goals of this study were to examine the orthopedic surgeons’ current practice regarding the management of equinus deformity in children with ambulatory CP, and analyze variations in current practice between general orthopedic and pediatric orthopedic surgeons.Methods: We implemented a brief cross-sectional self-reported questionnaire that addressed the areas of clinical examination and decision-making skills of management of equinus deformity in CP children. We targeted a convenience sample of 400 participants. Surgeons that provided complete responses to the questionnaire were 223 with a response rate of 56%, of which 123 (55%) were general orthopedic surgeons, whereas 100 (45%) were pediatric orthopedic surgeons. The target population consisted of orthopedic surgeons who were further sub-classified in accordance with practice age, general versus pediatric, and exposure to children’s orthopedics during the last three years of their practice. For analytical statistics, the Chi-Square test and Fisher’s exact test were used to examine the relationship between two qualitative variables.Results: The overall clinical practice preferences of all survey participants were unimpressive with discordant survey responses. Pediatric orthopedic surgeons generally demonstrated a statistically significant difference regarding clinical assessment skill items of the survey, in contrast to general orthopedic surgeons. However, we found no differences between pediatric orthopedic and general orthopedic surgeons regarding most of the decision-making/knowledge items.Discussion: Generally, there are insufficient clinical practice trends of both general and pediatric orthopedic surgeons regarding equinus treatment in CP children. This may indicate a knowledge–practice gap with potential risks to CP children undergoing surgery for equinus. There is a need for a more competent exposure to CP in orthopedic surgeons’ educational curricula and an updated health referral system.

The Impact of Comprehensive Care for Joint Replacement Bundled Payment Program on Care Delivery

BackgroundComprehensive Care for Joint Replacement (CJR) is a Medicare initiative to test the impact of holding a hospital accountable for services provided during an episode of care for a lower extremity joint arthroplasty on costs and quality. This study examines whether hospital participation in CJR is associated with having programs focused on improving posthospitalization care or reducing costs using a survey of orthopedic surgeons. MethodsSeventy-three (of 104) orthopedic surgeon members of the Hip Society, a national professional organization of hip surgeons, completed the survey. ResultsSurgeons practicing in CJR hospitals were more likely to report that their hospital had implemented programs focused on improving posthospitalization care or reducing costs. Surgeons in CJR hospitals were significantly more likely to report that the hospital had a narrow network of skilled nursing facilities to enhance care and limit length of stay in skilled nursing facilities (83% vs 47%, P < .01). Surgeons in CJR hospitals were also more likely to report the hospital provides incentives or some type of gainsharing. There were no statistically significant differences in implementation of having programs to reduce costs or improve care during hospitalization. ConclusionParticipation in CJR is associated with higher utilization of hospital practices aimed at improving postdischarge care and higher utilization of linking surgeon compensation to cost and quality.

Correction to: Management of symptomatic knee osteoarthritis in obesity: a survey of orthopaedic surgeons' opinions and practice.

The corresponding author would like to state a different e-mail address: drdanielhill@icloud.com.

Management of symptomatic knee osteoarthritis in obesity: a survey of orthopaedic surgeons' opinions and practice.

The aim of this survey was to explore knee surgeons' opinions and practices regarding the management of symptomatic knee osteoarthritis in obesity. Questionnaires were sent electronically to all consultant members of the British Association for Surgery of the Knee. The response rate was 52%. The survey showed considerable practice variation and divided opinion on the evidence base. The majority stated that weight loss should be the first-line treatment. 53% (91/172) stated that such cases should ideally be assessed by a specialist multidisciplinary service; however, only 24% (41/169) would be interested in being the orthopaedic surgeon in such a service. The optimal pathway of care for the obese patient with symptomatic knee osteoarthritis remains unclear. Given recent debate around the rationing of knee arthroplasty surgery in obesity, we felt it was timely to survey knee surgeons' current practice. Our survey has shown considerable variation in the opinions and practice of surgeons on the management of symptomatic knee osteoarthritis in obesity, together with divided views on current literature.

Skin closure following fractured neck of femur surgery: a survey of orthopaedic surgeons’ practices

Surgical intervention for patients presenting with a fractured neck of femur is common, however the best method of skin closure remains unclear. It has been suggested that the use of metallic skin clips in the closure of hip wounds may increase the rate of surgical site infections, however there are few high quality studies evaluating this. We designed a survey to assess surgeons preferred skin closure method and their reasons for choosing it. This was sent to 545 consultant orthopaedic surgeons. The positive response rate to our survey was 68% (n = 370). The survey showed that 44% of surgeons used metallic skin clips, and this was the most common method of closure reported. Hip surgeons were less likely to use metallic skin clips when compared to surgeons with other principal subspecialty practices. Surgeons using clips were most likely to state the rationale for use as convenience, whereas those using non-clip skin closure methods were more likely to cite reduced rates of wound inflammation, discharge, and infection as the rationale for use. Only a small proportion of surgeons indicate that their decisions were evidence based. Skin closure following surgery for fractured neck of femur is not consistent amongst surgeons and is not driven by evidence. Greater levels of evidence in this field are required to improve outcomes in this patient group.

Metal Hypersensitivity and Orthopedic Implants: Survey of Orthopedic Surgeons.

There is no clear consensus among orthopedic surgeons concerning metal hypersensitivity screening and orthopedic implants. This study investigated practices and opinions about metal hypersensitivity and orthopedic implants via a survey administered to practicing orthopedists. A questionnaire was sent to members of the Pennsylvania Orthopaedic Society electronically. Respondents were asked about preoperative and postoperative screening habits concerning metal hypersensitivity and implants. Forty-four physicians completed the survey. Only 11% of respondents reported that they always or often screen patients for metal hypersensitivity. Fifty percent of respondents stated that they only rarely refer patients for patch testing (and the remainder never do). If, however, patients were found to have a positive patch test, most providers were very likely to use a different implant. Other respondents were skeptical of the relationship between metal hypersensitivity and implant failure. Dermatitis, pain, and loosening were common reasons for postoperative testing. Seventy percent of respondents said that patch testing rarely or never changed their decision making. This study is reflective of the lack of consensus between orthopedists regarding patch testing. It demonstrates the diversity of opinions among orthopedists, the need for additional dialogue between orthopedic and dermatology specialties, and the need for larger studies investigating outcomes and metal hypersensitivity.

CORR Insights(®): Which Fixation Device is Preferred for Surgical Treatment of Intertrochanteric Hip Fractures in the United States? A Survey of Orthopaedic Surgeons.

CORR Insights(®): Which Fixation Device is Preferred for Surgical Treatment of Intertrochanteric Hip Fractures in the United States? A Survey of Orthopaedic Surgeons.

Which Fixation Device is Preferred for Surgical Treatment of Intertrochanteric Hip Fractures in the United States? A Survey of Orthopaedic Surgeons.

The best treatment for intertrochanteric hip fractures is controversial. The use of cephalomedullary nails has increased, whereas use of sliding hip screws has decreased despite the lack of evidence that cephalomedullary nails are more effective. As current orthopaedic trainees receive less exposure to sliding hip screws, this may continue to perpetuate the preferential use of cephalomedullary nails, with important implications for resident education, evidence-based best practices, and healthcare cost. We asked: (1) What are the current practice patterns in surgical treatment of intertrochanteric fractures among orthopaedic surgeons? (2) Do surgical practice patterns differ based on surgeon characteristics, practice setting, and other factors? (3) What is the rationale behind these surgical practice patterns? (4) What postoperative approaches do surgeons use for intertrochanteric fractures? A web-based survey containing 20 questions was distributed to active members of the American Academy of Orthopaedic Surgeons. Three thousand seven-hundred eighty-six of 10,321 invited surgeons participated in the survey (37%), with a 97% completion rate (3687 of 3784 responded to all questions in the survey). The survey elicited information regarding surgeon demographics, preferred management strategies, and decision-making rationale for intertrochanteric fractures. Surgeons use cephalomedullary nails most frequently for treatment of intertrochanteric hip fractures. Sixty-eight percent primarily use cephalomedullary nails, whereas only 19% primarily use sliding hip screws, and the remaining 13% use cephalomedullary nails and sliding hip screws with equal frequency. The cephalomedullary nail was the dominant approach regardless of experience level or practice setting. Surgeons who practiced in a nonacademic setting (71% versus 58%; p < 0.001), did not supervise residents (71% versus 61%; p < 0.001), or treated more than five intertrochanteric fractures a month (78% versus 67%; p < 0.001) were more likely to use primarily cephalomedullary nails. Of the surgeons who used only cephalomedullary nails, ease of surgical technique (58%) was cited as the primary reason, whereas surgeons who used only sliding hip screws cite familiarity (44%) and improved outcomes (37%) as their primary reasons. Of those who use only short cephalomedullary nails, ease of technique (59%) was most frequently cited. Postoperatively, 67% allow the patient to bear weight as tolerated. Nearly all respondents (99.5%) use postoperative chemical thromboprophylaxis. Despite that either sliding hip screw or cephalomedullary nail fixation are associated with equivalent outcomes for most intertrochanteric femur fractures, the cephalomedullary nail has emerged as the preferred construct, with the majority of surgeons believing that a cephalomedullary nail is easier to use, associated with improved outcomes, or is biomechanically superior to a sliding hip screw. The difference between what is evidence-based and what is done in clinical practice may be attributed to several factors, including financial considerations, educational experience, or inability of our current outcomes measures to reflect the experiences of surgeons. The educators, researchers, and policymakers among us must work harder to better define the roles of sliding hip screws and cephalomedullary nails and ensure that the increasing population with hip fractures receives high-quality and economically responsible care. Level V, therapeutic study.

The Choice Between Total Hip Arthroplasty and Arthrodesis in Adolescent Patients: A Survey of Orthopedic Surgeons

For adolescent patients with end-stage hip disease, the choice between total hip arthroplasty (THA) and arthrodesis is complex; the clinical evidence is not definitive, and there are difficult trade-offs between clear short-term benefits from THA and uncertain long-term risks. We surveyed nearly 700 members of the Pediatric Orthopedic Society of North America and the American Association of Hip and Knee Surgeons. Respondents chose between a recommendation of THA or arthrodesis in four clinical vignettes. A clear majority of surgeons recommended THA in two of the vignettes, however opinion was somewhat divided in one vignette (overweight adolescent) and deeply divided in another (adolescent destined for manual labor job). Across all vignettes, recommendations varied systematically according to surgeons' age and their attitudes regarding tradeoffs between life stages.