title: Are recent graduates of orthopaedic training programs performing less fracture care? American Board of Orthopedic Surgeons part II: a quality improvement initiative.
abstract: OBJECTIVE
  The purpose of this study was to evaluate whether there has been a change in the amount of fracture care performed by recent graduates of orthopaedic residency programs over time.
  
  
  METHODS
  Retrospective review.
  
  
  METHODS
  American Board of Orthopaedic Surgery (ABOS) Part II database.
  
  
  METHODS
  Candidates applying for Part II of the second part of the Orthopaedic (ABOS) certification.
  
  
  METHODS
  The ABOS Part II database was searched from years 1999 to 2008 for Current Procedural Terminology codes indicating 1) "simpler fractures" that any candidate surgeon should be able to perform; 2) "complex fractures" that are often referred to surgeons with specialty training; and 3) "emergent cases" that should be done emergently by a physician.
  
  
  METHODS
  Logistic regression and chi-square tests were used to evaluate whether there has been a change in the amount of fracture care among recent graduates of orthopaedic residency programs over time.
  
  
  RESULTS
  Over the 10-year period (1999-2008), a total of 95,922 cases were in the simpler fractures category; 16,523 were classified as complex fractures and 17,789 were classified as emergent cases. The overall number of cases by fracture type increased from 1999 to 2008 as did the average number of surgery cases performed by surgeons in each category over the 6-month collection period. Simpler fracture cases increased 18% (8304-9784 cases) with the average number surgically treated by surgeons performing at least one simple fracture case also increasing 18% (14.1-16.6 cases per surgeon). Complex fracture cases increased 51% (1266-1916 cases) with the average number of these cases per surgeon operating at least one complex fracture case increasing 52% (3.3-5.0 cases per surgeon). Emergent fracture cases increased 92% (1178-2264 cases) with the average number of these cases per surgeon operating at least one emergent fracture case increasing 49% (4.5-6.7 cases per surgeon).
  
  
  CONCLUSIONS
  From the data presented here, candidate orthopaedic surgeons are treating fractures as least as often as young surgeons were 10 years ago.
authors.affiliation: Department of Orthopaedics, Dartmouth Hitchcock Medical Center, Lebanon, NH. kjkmd@yahoo.com
authors.forename: Kenneth J
authors.initials: KJ
authors.lastname: Koval
authors.forename: Larry
authors.initials: L
authors.lastname: Marsh
authors.forename: Jeff
authors.initials: J
authors.lastname: Anglen
authors.forename: James
authors.initials: J
authors.lastname: Weinstein
authors.forename: John J
authors.initials: JJ
authors.lastname: Harrast
mesh_terms: D004503:Education, Medical, Graduate; D005592:Fracture Fixation / Q000706:statistics & numerical data / Q000639:trends*; D006801:Humans; D009985:Orthopedics / Q000193:education* / Q000706:statistics & numerical data; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data / Q000639:trends*; D012955:Societies, Medical