AO pelvic fracture classification: can an educational package improve orthopaedic registrar performance?

Background: The unstable pelvic fracture has been described as the ‘killing fracture’ because of the risk of significant vascular compromise. The ability to correctly classify pelvic fractures may therefore be crucial in optimizing patient outcomes. Pelvic fracture classification is difficult and previous research has indicated that ability is suboptimal in orthopaedic registrars. The objective of this study was to examine the efficacy of an educational package in improving orthopaedic registrars’ ability to classify pelvic fractures. Methods: A total of 35 orthopaedic registrars were recruited in this classification study. An educational package was used to introduce the AO classification of pelvic fractures and teach the registrars how to classify pelvic fractures using pelvic X-rays and computed tomography scans. A classification test assessed their classification ability before and after using the educational package. A third test was performed 2 weeks after the second to assess the stability of learning. Results: The mean score at baseline of 8.4 ± 0.46 increased to 10.5 ± 0.48 after using the educational package, and this was maintained in the follow-up test (10.7 ± 0.54 (F(2,52) = 15.5, P < 0.001)). The proportion of registrars achieving a satisfactory score increased from 46% (16/35) to 77% (23/30) after training, and 90% (19/21) at follow-up (χ²(2) = 6.74, P = 0.035). Conclusion: The reliability with which orthopaedic registrars classified pelvic fractures was improved using an educational package. An educational package on pelvic fracture classification may prove to be a valuable addition to the orthopaedic training programme.