Defining Percentiles for Cases Performed During Accreditation Council for Graduate Medical Education Accredited Orthopaedic Trauma Training.

Objectives: Accrediting bodies in orthopaedic trauma education are adopting case minimum requirements to enhance orthopaedic trauma fellowship training. This study defined case volume percentiles during Accreditation Council for Graduate Medical Education (ACGME)-accredited orthopaedic trauma fellowship training.

Methods: This was a retrospective cohort study of orthopaedic trauma fellows graduating from ACGME-accredited programs (2018-2023). Percentiles for reported case volumes were calculated across ACGME-defined case categories. Variability was defined as fold-differences between the 90th and 10th percentiles of orthopaedic trauma fellows by case volume. Annual trends in reported case volumes were analyzed with linear regression. Sensitivity analyses were performed to identify potential case minimum requirements.

Results: There were 117 orthopaedic trauma fellows included in this study, which represented all ACGME-accredited fellows from 2018 to 2023. Mean annual reported case volume did not change significantly over the study period (505 ± 126 to 558 ± 106, 10.5% increase, P=0.176). Pediatric cases accounted for a minority of cases (1.2%). Reported cases were mostly in pelvis / hip (n=123, 25%), femur / knee (n=100, 20%), and leg / ankle (n=86, 17%). Variability in reported case volumes between the 90th and 10th percentiles was greatest in fasciotomy (20.5-fold), debridement (8.4-fold), and external fixation (5.8-fold). The tenth and thirtieth percentiles of ACGME-accredited orthopaedic trauma fellows reported a total of 343 and 431 cases, respectively.

Conclusions: Analysis of reported case volumes from ACGME-accredited orthopaedic trauma fellows suggest performance of 343 and 431 cases to achieve tenth and thirtieth percentiles, respectively. Understanding areas of case volume variability can assist future fellows and faculty improve operative training experiences during orthopaedic trauma fellowship training.