The Fracture Fixation Assessment Tool score (FFATs) was developed as an objective evaluation of post-operative fracture fixation radiographs as a means of appraisal and education. The tool has proven validity, simple to use and based upon AO principles of fracture fixation. This study has been designed to assess how FFATs changes throughout the training program in the UK. The local trauma database of a district general hospital, with trauma unit status was used to identify cases. Although FFATs is designed to apply to any fracture fixation, Weber B ankle fractures were selected as common injuries, which constitute indicative cases in T&O training. Grade of the primary surgeon and supervision level were both stratified. The initial and intraoperative radiographs were anonymised and presented to the assessor who had been blinded to the identity and grade of the surgeon, for scoring using FFATs.Background
Methods
Intramedullary nails are a well accepted method of fixing fractures of the femur, however there are several potential complications associated with femoral nail insertion. One under-reported complication is perforation of the anterior cortex of the distal femur. Cortical perforation is well documented in immature bone however there is little evidence of perforation in skeletally mature adults. We present a 5 year retrospective clinical audit into correct positioning of the TriGen™ intramedullary nail system (Smith & Nephew Inc.), with respect to determining the anterior cortex perforation rate. Cases were identified using searches of the electronic operation notes, followed by manual cross checking of the reference numbers of the implants used. The radiographs for each case were then checked to identify cases of distal anterior cortex perforation. 138 femoral nails were inserted over the 5 years 2005–2010 at our institution. 79 cases met the inclusion criteria, of which 8 were deemed to show radiological evidence of cortical perforation on lateral view, this represents a perforation rate of 10.1% in this population. There was also a significant difference in the mean age of the perforated vs non-perforated groups (80.1 vs 62.1 yrs respectively). These results are at odds with the current literature which reports few or no cases of cortical perforation. As a result of this audit we have made various recommendations for future practice. This study highlights a need for larger scale randomised trials to be carried out in the future.
