A modified anterolateral swashbuckler approach for distal femoral fractures: description and outcomes.

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Abstract

[Indexed for MEDLINE] Conflict of interest statement: Each author declares that he or she has no commercial associations (e.g. consultancies, stock ownership, equity interest, patent/licensing arrangement etc.) that might pose a conflict of interest in connection with the submitted article. 8. Injury. 2018 Dec;49(12):2227-2233. doi: 10.1016/j.injury.2018.09.019. Epub 2018 Sep 11. AO international consensus panel for metrics on a closed reduction and fixation of a 31A2 pertrochanteric fracture. Kojima K(1), Graves M(2), Taha W(3), Cunningham M(4), Joeris A(5), Gallagher AG(6). Author information: (1)Chief Orthopedic Trauma Group, Instituto de Ortopedia, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil. Electronic address: kodikojima@uol.com.br. (2)Hansjörg Wyss AO Medical Foundation Chair of Orthopaedic Trauma, University of Mississippi Medical Center, Jackson, MS, USA. Electronic address: mattgraves@me.com. (3)Head division of Orthopedics, King Abdulaziz Medical City, Al-Madinah, Saudi Arabia,. Electronic address: waeltaha@me.com. (4)Head Medical Affairs and Health Economics, AO Foundation, Clinical Investigation and Documentation (AOCID), Switzerland. Electronic address: michael.cunningham@aofoundation.org. (5)Senior Project Manager Curriculum Development, AO Foundation, AO Education Institute, Stettbachstrasse 6, 8600, Duebendorf, Switzerland. Electronic address: alexander.joeris@aofoundation.org. (6)Director of Research, ASSERT Centre, College of Medicine and Health, University College Cork, Ireland. Electronic address: anthonyg.gallagher@btinternet.com. BACKGROUND: The foundations of an effective and evidence-based training program are the metrics, which characterize optimal performance. PURPOSES: To develop, operationally define, and seek consensus from procedure experts on the metrics that best characterize a reference approach to the performance of a closed reduction and internal fixation of a 31A2 unstable pertrochanteric fracture with a cephalomedullary nail with distal locking through the proximal guide. METHODS: A Metrics Group consisting of 3 senior orthopaedic surgeons, a surgeon/medical scientist, an education expert and a behavioural scientist deconstructed the performance of the selected fixation procedure and defined performance metrics. At a modified Delphi meeting, 32 senior orthopaedic and trauma surgeons from 18 countries critiqued these metrics and their operational definitions before reaching consensus. RESULTS: Initially performance metrics consisting of 14 Phases with 62 Steps, 84 errors and 20 Sentinel errors were identified that characterize the safe and effective performance of the procedure. During the Delphi panel meeting these were modified and consensus was reached on 15 Phases (1 added, p = 0.967)) with 75 Steps (14 added and 1 deleted; p = 0.028), 88 errors (10 added and 6 deleted; p = 0.47), and 28 Sentinel errors (8 added; p = 0.107). Pre and Post Delphi characterizations were highly correlated (r = 0.81-0.94). CONCLUSIONS: Surgical procedures can be broken down into constituent, essential, and elemental tasks necessary for the safe and effective completion of a reference approach to a specified procedure. Procedure experts from 18 countries reached consensus on performance metrics for the fixation procedure. This metric-based characterization should form the basis of more quantitative validation studies to guide the construction of a proficiency-based progression training curriculum. Copyright © 2018 The Authors. Published by Elsevier Ltd.. All rights reserved. DOI: 10.1016/j.injury.2018.09.019