The Effect of Surgeon's Experience on Implant Selection in the Management of Geriatric Unstable Intertrochanteric Femur Fractures.

Background: This study aimed to evaluate how orthopedic surgeon's professional experience affects implant selection in the surgical treatment of geriatric unstable intertrochanteric femur fractures. Methods: Plain radiographs of 107 patients aged ≥ 75 years with AO type 31 A2.2 or A2.3 fractures, Singh index ≤ 3, and cumulative ambulation score ≥ 5 were assessed by orthopedic surgeons with varying levels of experience. Surgeons chose between proximal femoral nail (PFN), dynamic hip screw (DHS), and hip arthroplasty (total or hemi) for each case. Participants were grouped by experience: junior (≤ 5 years), middle (6-10 years), and senior (≥ 11 years), each with 9 surgeons. Preferences across groups were statistically compared. Results: All observers chose PFN or hemiarthroplasty (HA), while none preferred DHS or total arthroplasty. Junior surgeons predominantly preferred PFN. As experience increased, preference shifted toward HA. Senior surgeons overwhelmingly chose HA, while middle-experienced surgeons preferred PFN and HA at close rates. Conclusion: Implant selection is shaped not only by fracture type but also by the surgeon's clinical experience. Surgeons with greater experience more frequently choose arthroplasty, likely due to greater technical ability, complication management skills, and awareness of long-term outcomes.