Abstract
Purpose
Our hypothesis was that closed tibia fractures treated with intramedullary nails are impacted by surgeon and center volumes.
Method
Data from 813 patients with closed tibia fractures were obtained from the SPRINT study. Using multiple regression, we examined the effect of center and surgeon volume (categorized as high, moderate, or low), and geographic differences by country (Canada, USA, and the Netherlands) on health-related quality-of-life and revision surgeries to gain union at one year. Our measures of quality-of-life were the Short-Form 36 Health Survey Questionnaire (SF-36 PCS) and the Short Musculoskeletal Function Assessment (SMFA).
Results
Patients treated by moderate volume surgeons had a reduced risk of reoperation versus patients treated by low volume surgeons (odds ratio =0.54, 95% CI = 0.33 to 0.89, p=0.02). No effects of surgeon volume were seen for the other outcomes. Patients treated at moderate volume centers had poorer quality of life at one year than patients treated at low volume centers, based on the SMFA Bother score (difference = 7.33, 95% CI = 2.65 to 12.01). This effect was not seen with the other outcomes. Patients with isolated fractures have better quality-of-life at one year, based on all three measures, p<0.001. Older patients have poorer SMFA scores at one year than younger patients, p<0.001. There were no significant differences by country.
Conclusion
The traditional volume versus outcome relationship for closed tibial fractures within intramedullary nailing does not hold. Further analyses in other areas of orthopaedic trauma surgery are advisable.
