Thurs., 10/8/09 Pediatrics & Injury Prevention, Paper #28, 2:58 pm OTA-2009
Dispelling the Myth: Emergency Fracture Care, Who’s Doing What?
Kenneth J. Koval, MD1 (3, 4, 5A, 10-Biomet; 4, 5A, 10-Stryker);
Jeffrey O. Anglen, MD2 (3-Biomet; 5A, 7-Stryker; 7-Wyeth; 9-Journal of the American Academy of Orthopaedic Surgeons); James Weinstein, DO, MS1 (n);
J. Lawrence Marsh, MD3 (3-Biomet; 7, 10-Smith &Nephew);
John J. Harrast, MS4(5-Web Data Solutions);
1Dartmouth Hitchcock Medical Center, Lebanon, New Hampshire, USA;
2Indiana University, Indianapolis, Indiana, USA;
3University of Iowa, Iowa City, Iowa, USA;
4Web Data Solutions, Hinsdale, Illinois, USA
Purpose: The OTA has long held that orthopaedic surgeons participate in the care of trauma patients. However, it has recently been suggested that younger orthopaedic surgeons are not participating in trauma care as part of their clinical practice. This study was performed to evaluate whether there has been a change in the distribution of fracture care among recent graduates of orthopaedic residency programs over time and whether this change might be related to subspecialization.
Methods: The American Board of Orthopaedic Surgery (ABOS) Part II database was searched from years 1999 to 2008 for CPT codes indicating (1) “simpler fractures” that any candidate surgeon should be able to perform (eg, open reduction and internal fixation [ORIF] of hip or ankle, intramedullary nailing of tibia or femur); (2) “complex fractures,” which are often referred to surgeons with specialty training (eg, ORIF of periarticular fractures, pelvis, acetabulum fractures); and (3) “emergent cases,” which should be done emergently by the on-call physician (eg, irrigation and débridement of open fracture, compartment release). Descriptive statistics were performed for all outcomes. Logistic regression and chi-square tests were used to evaluate the relationships between fracture care distribution and practitioner descriptors, including fellowship training and region of the country.
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 substantially from 1999 to 2008, as did the average number of surgery cases performed in each category. Simpler fracture cases increased 18% (8,304 to 9,784 cases), with the average number surgically treated by surgeons performing at least 1 simple fracture case also increasing 18% (14.1 to 16.6 cases per surgeon). Complex fracture cases increased 51% (1,266 to 1,916 cases), with the average number of these cases per surgeon operating at least 1 complex fracture case increasing 52% (3.3 to 5.0 cases per surgeon). Emergent fracture cases increased 92% (1,178 to 2,264 cases), with the average number of these cases per surgeon operating at least 1 emergent fracture case increasing 49% (4.5 to 6.7 cases per surgeon). There were demonstrated trends over time with higher percentages of surgeons performing larger numbers of these procedures in recent years. Declared subspecialty had a substantial effect on the number of candidates performing the 3 types of cases. Declared trauma surgeons performed significantly more simple, complex, and emergent cases on average than general orthopaedists and each other subspecialist (P <0.001 for each fracture type).
Conclusion: From the data presented here, young surgeons are taking emergency call and, in fact, they have experienced a significant increased case load for all 3 case types. This increase in the number of cases performed by the candidate surgeons was somewhat surprising, but may reflect the increase in techniques and devices available to treat fractures and may have nothing to do with the notion that some orthopaedists are avoiding trauma coverage.
• The FDA has not cleared this drug and/or medical device for the use described in this presentation (i.e., the drug or medical device is being discussed for an “off label” use). ◆FDA information not available at time of printing. Δ OTA Grant