title: Is proximal femoral nailing a good procedure for teaching in orthogeriatrics?
abstract: BACKGROUND
  Proximal femoral nailing is a common operation in orthogeriatrics and a highly standardized procedure. For teaching purposes, this operation is often performed by residents and supervised by attending physicians. The objective of this study is to investigate if teaching this operation influences the surgical in-house complication rate.
  
  
  METHODS
  All patients who received a proximal femoral Targon PF nail (Aesculap AG, Tuttlingen, Germany) for trochanteric fractures were included in a cohort at our urban academic teaching hospital between 1998 and 2010. To evaluate potential effects of patient age, we separately analyzed several age groups. Complications including wound infection, hematoma, intraoperative malreduction or implant malpositioning causing revision, pain, cut-out and readmission due to nonunion were recorded.
  
  
  RESULTS
  Our collective consists of 1,516 patients (m/f: 410/1,106). The mean age was 78.7 years (range: 19-103 years). The overall complication rate was 7.9 %. In 857 cases operated by attending physicians, the complication rate was 6.9 %. However in the 659 operations performed by residents, we found a higher complication rate of 9.3 %. Further investigating this difference by χ(2) test, we found no significance (p = 0.09). Whilst analyzing the complication rates for the different age groups, we did not find a statistically significant difference except in the age group between 71 and 80 years, for which the odds ratio indicated a 2.6-fold increased complication risk for operations performed by residents (p = 0.01). Further analysis revealed that this increased complication rate was mainly due to increased numbers of cut-out.
  
  
  CONCLUSIONS
  We conclude that proximal femoral nailing is an operation suitable for teaching purposes. However, patients between 71 and 80 years of age seem to be at an increased risk for cut-out if operated by a resident.
authors.affiliation: Department of Trauma and Orthopaedic Surgery, Klinikum Nürnberg, Breslauer Strasse 201, Nürnberg, Germany. biber@klinikum-nuernberg.de
authors.forename: R
authors.initials: R
authors.lastname: Biber
authors.forename: S
authors.initials: S
authors.lastname: Grüninger
authors.forename: K
authors.initials: K
authors.lastname: Singler
authors.forename: C C
authors.initials: CC
authors.lastname: Sieber
authors.forename: H J
authors.initials: HJ
authors.lastname: Bail
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D001858:Bone Nails; D005260:Female; D005593:Fracture Fixation, Internal / Q000193:education* / Q000295:instrumentation; D005853:Geriatrics / Q000193:education*; D005858:Germany; D006620:Hip Fractures / Q000601:surgery*; D006801:Humans; D016268:Internal Fixators; D007396:Internship and Residency; D007431:Intraoperative Complications / Q000453:epidemiology / Q000209:etiology; D008297:Male; D008875:Middle Aged; D009985:Orthopedics / Q000193:education*; D011183:Postoperative Complications / Q000453:epidemiology / Q000209:etiology; D012189:Retrospective Studies