title: Variations of treatment in selected proximal femur fractures among surgeons with different surgical experience--A survey at an international AO course.
abstract: BACKGROUND
  Different modalities of treatment for hip fractures have been discussed in the literature; however, practice may vary between centres. A survey was conducted on participants at an international AO course to assess the current management of pertrochanteric fractures (AO/OTA 31-A2) and displaced, non-impacted, subcapital fractures (AO/OTA 31-B3) in a 35-year-old patient and an 85-year-old patient.
  
  
  METHODS
  Surgeons taking part in an international orthopaedic course were invited to participate in a survey and were divided into two groups: inexperienced (one-to-three years since qualification) and experienced (four or more years). A survey was conducted to assess the management modalities used for pertrochanteric fractures (AO/OTA 31-A2) and displaced, non-impacted, subcapital fractures (AO/OTA 31-B3) in a 35-year-old patient and an 85-year-old patient.
  
  
  RESULTS
  Fifty-two surgeons participated: 18 were inexperienced and 34 were experienced. The method of operative fixation for the pertrochanteric fracture was gamma-nailing for 95% of the surgeons in the inexperienced group; in the experienced group, 56% opted for gamma-nailing and 38% for dynamic hip screw (DHS). For the displaced subcapital fracture in a 35-year-old, screw fixation was the dominant treatment option for both groups. For the displaced subcapital fracture in an 85-year-old, most of the surgeons in both groups preferred hemiarthroplasty: 59% in the inexperienced group chose cemented bipolar hemiarthroplasty and 12% uncemented, whereas 56% of the experienced group suggested cemented bipolar hemiarthroplasty and 25% uncemented.
  
  
  CONCLUSIONS
  This survey shows that a variety of methods are used to treat femoral neck fractures. A prospective randomised trial has shown the DHS to be the implant of choice for pertrochanteric fractures; however, this was not considered an option in the inexperienced group of surgeons and was the treatment of choice in only 13 out of 34 experienced surgeons. There is a general consensus for femoral head-conserving surgery in young patients with displaced subcapital fractures. Replacement arthroplasty was considered in the 85-year-old with a subcapital fracture. In the inexperienced group, 10 of 17 surgeons would cement the prosthesis, as would 27 of 36 in the experienced group.
authors.affiliation: Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom. Electronic address: sarasciacca@hotmail.com.
authors.forename: Sara
authors.initials: S
authors.lastname: Sciacca
authors.affiliation: Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom. Electronic address: surjitlidder@me.com.
authors.forename: Surjit Singh
authors.initials: SS
authors.lastname: Lidder
authors.affiliation: Medical University of Graz, Graz, Austria.
authors.forename: Christoph
authors.initials: C
authors.lastname: Grechenig
authors.affiliation: University Hospital Regensburg, Regensburg, Germany.
authors.forename: Stephan
authors.initials: S
authors.lastname: Grechenig
authors.affiliation: University Hospital Merkur, Orthopaedics and Trauma Department, Zagreb, Croatia.
authors.forename: Mario
authors.initials: M
authors.lastname: Staresinic
authors.affiliation: General Hospital Karlovac, Orthopaedics and Trauma Department, Croatia. Electronic address: borebakota@yahoo.com.
authors.forename: Bore
authors.initials: B
authors.lastname: Bakota
authors.affiliation: Department of Trauma, Orthopaedics and Hand Surgery, Wolfsburg, Germany.
authors.forename: Axel
authors.initials: A
authors.lastname: Gänsslen
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D019644:Arthroplasty, Replacement, Hip / Q000706:statistics & numerical data*; D001843:Bone Cements; D002983:Clinical Competence / Q000706:statistics & numerical data; D032921:Consensus; D005260:Female; D005265:Femoral Neck Fractures / Q000601:surgery*; D005593:Fracture Fixation, Internal / Q000379:methods*; D019538:Health Care Surveys; D062785:Hemiarthroplasty / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D009985:Orthopedics / Q000193:education; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D011446:Prospective Studies; D066231:Surgeons; D016896:Treatment Outcome
chemical_list: D001843:Bone Cements
keywords: Proximal femur fractures; Surgical experience; Survey; Treatment