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Chuang H, Kuan F, Su W, Shih C, Chiang C, Ko P, Hong C, Chen Y, Hsu K. Evaluating effectiveness of cadaveric arthroscopic training for orthopaedic residents: A comparison of joints and training levels. J Exp Orthop 2024; 11:e12030. [PMID: 38774580 PMCID: PMC11106551 DOI: 10.1002/jeo2.12030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2024] [Revised: 03/19/2024] [Accepted: 04/22/2024] [Indexed: 05/24/2024] Open
Abstract
Purpose This study aimed to evaluate the effects and interactions of training level and different joints on the outcomes of cadaveric arthroscopic training courses for orthopaedic residents. Methods This prospective study enrolled 16 orthopaedic residents who voluntarily participated in a cadaveric training programme involving the shoulder, elbow, wrist, knee and ankle joints. Outcomes were quantitatively assessed using task-specific checklists and the Arthroscopic Surgery Skill Evaluation Tool. Two-way analysis of variance (ANOVA) was conducted to determine the significance of the interactions between joint and years of training. Results Resident scores significantly increased after the dedicated lectures in all five joints (p = 0.003 for the shoulder module, p < 0.001 for the other joints). Two-way ANOVA revealed that the progress made after the dedicated lectures was significantly impacted by the joint (p = 0.006) and training level × joint interaction (p = 0.005) but not by the training level (p = 0.47). The simple effect of the joint was examined using Sidak's multiple comparison test. Among junior residents, the dedicated lectures resulted in more substantial progress in elbow and wrist arthroscopy when compared to shoulder arthroscopy (p = 0.020 and p = 0.043, respectively). Conclusions The results suggest that, in cadaveric arthroscopic training courses for orthopaedic residents, training outcomes are primarily impacted by the specific joint being trained rather than the training level. Specifically, junior residents demonstrated greater improvement with training in procedures that are less commonly encountered during on-the-job training, such as elbow and wrist arthroscopy. Clinical Relevance These findings suggest the need to prioritise wrist and elbow arthroscopic training for junior residents to optimise educational outcomes. Level of Evidence Level III.
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Affiliation(s)
- Hao‐Chun Chuang
- Department of Orthopaedic Surgery, National Cheng Kung University Hospital, College of MedicineNational Cheng Kung UniversityTainanTaiwan
| | - Fa‐Chuan Kuan
- Department of Orthopaedic Surgery, National Cheng Kung University Hospital, College of MedicineNational Cheng Kung UniversityTainanTaiwan
- Department of Biomedical EngineeringNational Cheng Kung UniversityTainanTaiwan
| | - Wei‐Ren Su
- Department of Orthopaedic Surgery, National Cheng Kung University Hospital, College of MedicineNational Cheng Kung UniversityTainanTaiwan
- Skeleton Materials and Bio‐compatibility Core Lab, Research Center of Clinical Medicine, National Cheng Kung University Hospital, College of MedicineNational Cheng Kung UniversityTainanTaiwan
- Musculoskeletal Research Center, Innovation HeadquartersNational Cheng Kung UniversityTainanTaiwan
| | - Chien‐An Shih
- Department of Orthopaedic Surgery, National Cheng Kung University Hospital, College of MedicineNational Cheng Kung UniversityTainanTaiwan
- Skeleton Materials and Bio‐compatibility Core Lab, Research Center of Clinical Medicine, National Cheng Kung University Hospital, College of MedicineNational Cheng Kung UniversityTainanTaiwan
- Musculoskeletal Research Center, Innovation HeadquartersNational Cheng Kung UniversityTainanTaiwan
| | - Chen‐Hao Chiang
- Department of Biomedical EngineeringNational Cheng Kung UniversityTainanTaiwan
- Department of OrthopaedicsDitmanson Medical Foundation Chia‐Yi Christian HospitalChiayiTaiwan
| | - Po‐Yen Ko
- Department of Orthopaedic Surgery, National Cheng Kung University Hospital, College of MedicineNational Cheng Kung UniversityTainanTaiwan
- Skeleton Materials and Bio‐compatibility Core Lab, Research Center of Clinical Medicine, National Cheng Kung University Hospital, College of MedicineNational Cheng Kung UniversityTainanTaiwan
- Musculoskeletal Research Center, Innovation HeadquartersNational Cheng Kung UniversityTainanTaiwan
| | - Chih‐Kai Hong
- Department of Orthopaedic Surgery, National Cheng Kung University Hospital, College of MedicineNational Cheng Kung UniversityTainanTaiwan
| | - Yueh Chen
- Skeleton Materials and Bio‐compatibility Core Lab, Research Center of Clinical Medicine, National Cheng Kung University Hospital, College of MedicineNational Cheng Kung UniversityTainanTaiwan
- Musculoskeletal Research Center, Innovation HeadquartersNational Cheng Kung UniversityTainanTaiwan
- Department of OrthopedicsKaohsiung Veterans General Hospital Tainan BranchTainanTaiwan
| | - Kai‐Lan Hsu
- Department of Orthopaedic Surgery, National Cheng Kung University Hospital, College of MedicineNational Cheng Kung UniversityTainanTaiwan
- Department of Biomedical EngineeringNational Cheng Kung UniversityTainanTaiwan
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Familiari F, Chahla J, Compagnoni R, DePhillipo NN, Moatshe G, LaPrade RF. Meniscal extrusion consensus statement: A collaborative survey within the Meniscus International Network (MenIN) Study Group. Knee Surg Sports Traumatol Arthrosc 2024; 32:1446-1454. [PMID: 38606565 DOI: 10.1002/ksa.12183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2024] [Revised: 03/21/2024] [Accepted: 04/02/2024] [Indexed: 04/13/2024]
Abstract
PURPOSE The purpose of the present study was to perform a survey administered to members of the Meniscus International Network (MenIN) Study Group, seeking to delineate the most contentious aspects of meniscal extrusion classification and provide a foundation for new, more comprehensive definitions and treatments for these pathologies. METHODS MenIN Study Group is a group of international experts treating and performing research on meniscus pathology and treatment. All MenIN Study Group members were asked to complete a survey aimed at establishing criteria for the optimal classification system for meniscal extrusion. Data obtained from the completed questionnaires were transferred into a spreadsheet and then analysed. All responses are presented as counts, percentages or means. RESULTS Forty-seven (85.5%) MenIN Study Group members completed the survey and were included in this analysis. Key aspects recommended for inclusion in a comprehensive classification system for meniscal extrusion included laterality (93.6%), anatomical location (76.6%), patient age (76.6%), body mass index (BMI) (68.1%) and aetiology (68.1%). For classifying meniscal extrusion, 53.2% considered the distance in millimetres from the tibial plateau's outer margin as the most reliable measurement technique on imaging. Preferences for imaging modalities varied, with 44.7% favouring weight-bearing magnetic resonance imaging (MRI) and 36.2% opting for weight-bearing ultrasound due to its greater availability. Respondents advocated for a classification system addressing stability or progression of meniscal extrusion (66%), reducibility (53.2%), potential progression of knee osteoarthritis (OA) (83%), influencing treatment approaches (83%), a gradation system (83%), consideration of dynamic factors (66%), association with clinical outcomes and prognosis (76.6%) and investigation around centralization procedures (57.4%). CONCLUSIONS In conclusion, the findings of this survey shed light on the global perspectives regarding meniscal extrusion classification. It was generally felt that a new classification of extrusion measured on MRI scans at the mid-tibial plateau should be developed, which considers factors such as laterality, anatomical location, age, BMI and aetiology. Additionally, the results support the integration of dynamic factors and clinical outcomes in MRI-based classifications to inform treatment approaches. LEVEL OF EVIDENCE Level IV.
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Affiliation(s)
- Filippo Familiari
- Department of Orthopaedic and Trauma Surgery, Magna Graecia University, Catanzaro, Italy
- Research Center on Musculoskeletal Health, Magna Graecia University, Catanzaro, Italy
| | - Jorge Chahla
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, USA
- Midwest Orthopaedics at Rush, Chicago, Illinois, USA
| | - Riccardo Compagnoni
- U.O.C. 1° Clinica Ortopedica, ASST G. Pini-CTO, Milan, Italy
- Department of Biomedical, Surgical and Dental Sciences, Università degli Studi di Milano, Milan, Italy
| | - Nicholas N DePhillipo
- Department of Orthopedics, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Gilbert Moatshe
- Norwegian School of Sports Science, Oslo Sport Trauma Research Center, Oslo, Norway
- Orthopaedic Clinic, Oslo University Hospital Ullevål, Oslo, Norway
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Fidanza A, Caggiari G, Di Petrillo F, Fiori E, Momoli A, Logroscino G. Three-dimensional printed models can reduce costs and surgical time for complex proximal humeral fractures: preoperative planning, patient satisfaction, and improved resident skills. J Orthop Traumatol 2024; 25:11. [PMID: 38418743 PMCID: PMC10902230 DOI: 10.1186/s10195-024-00754-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Accepted: 02/08/2024] [Indexed: 03/02/2024] Open
Abstract
BACKGROUND Proximal humeral fractures (PHFs) are still controversial with regards to treatment and are difficult to classify. The study's objective is to show that preoperative planning performed while handling a three-dimensional (3D) printed anatomical model of the fracture can ensure a better understanding of trauma for both surgeons and patients. MATERIALS AND METHODS Twenty patients (group A, cases) with complex PHF were evaluated preoperatively by reproducing life-size, full-touch 3D anatomical models. Intraoperative blood loss, radiographic controls, duration of surgery, and clinical outcomes of patients in group A were compared with 20 patients (group B, controls) who underwent standard preoperative evaluation. Additionally, senior surgeons and residents, as well as group A patients, answered a questionnaire to evaluate innovative preoperative planning and patient compliance. Cost analysis was evaluated. RESULTS Intraoperative radiography controls and length of operation were significantly shorter in group A. There were no differences in clinical outcomes or blood loss. Patients claim a better understanding of the trauma suffered and the proposed treatment. Surgeons assert that the planning of the definitive operation with 3D models has had a good impact. The development of this tool has been well received by the residents. The surgery was reduced in length by 15%, resulting in savings of about EUR 400 for each intervention. CONCLUSIONS Fewer intraoperative radiography checks, shorter surgeries, and better patient compliance reduce radiation exposure for patients and healthcare staff, enhance surgical outcomes while reducing expenses, and lower the risk of medicolegal claims. LEVEL OF EVIDENCE Level I, prospective randomized case-control study.
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Affiliation(s)
- Andrea Fidanza
- Unit of Orthopaedics, Department of Life, Health and Environmental Sciences, University of L'Aquila (IT), Piazzale S.Tommasi, 1, 67100, L'Aquila, Italy.
| | - Gianfilippo Caggiari
- Orthopaedic and Traumatology Department, Sassari University Hospital, Sassari, Italy
| | - Francesco Di Petrillo
- Unit of Orthopaedics, Department of Life, Health and Environmental Sciences, University of L'Aquila (IT), Piazzale S.Tommasi, 1, 67100, L'Aquila, Italy
| | - Enrico Fiori
- Orthopaedic and Traumatology Department, Sassari University Hospital, Sassari, Italy
| | - Alberto Momoli
- Unit of Trauma and Orthopaedic, San Bortolo Hospital, Vicenza, Italy
| | - Giandomenico Logroscino
- Unit of Orthopaedics, Department of Life, Health and Environmental Sciences, University of L'Aquila (IT), Piazzale S.Tommasi, 1, 67100, L'Aquila, Italy
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Carbone M, Viglialoro RM, Stagnari S, Condino S, Gesi M, Scaglione M, Parchi PD. Design, Fabrication, and Preliminary Validation of Patient-Specific Spine Section Phantoms for Use in Training Spine Surgeons Outside the Operating Room/Theatre. Bioengineering (Basel) 2023; 10:1345. [PMID: 38135936 PMCID: PMC10740604 DOI: 10.3390/bioengineering10121345] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Revised: 11/13/2023] [Accepted: 11/21/2023] [Indexed: 12/24/2023] Open
Abstract
Pedicle screw fixation (PSF) demands rigorous training to mitigate the risk of severe neurovascular complications arising from screw misplacement. This paper introduces a patient-specific phantom designed for PSF training, extending a portion of the learning process beyond the confines of the surgical room. Six phantoms of the thoracolumbar region were fabricated from radiological datasets, combining 3D printing and casting techniques. The phantoms were employed in three training sessions by a fifth-year resident who performed full training on all six phantoms; he/she placed a total of 57 pedicle screws. Analysis of the learning curve, focusing on time per screw and positioning accuracy, revealed attainment of an asymptotic performance level (around 3 min per screw) after 40 screws. The phantom's efficacy was evaluated by three experts and six residents, each inserting a minimum of four screws. Initial assessments confirmed face, content, and construct validity, affirming the patient-specific phantoms as a valuable training resource. These proposed phantoms exhibit great promise as an essential tool in surgical training as they exhibited a demonstrable learning effect on the PSF technique. This study lays the foundation for further exploration and underscores the potential impact of these patient-specific phantoms on the future of spinal surgical education.
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Affiliation(s)
- Marina Carbone
- Department of Information Engineering, University of Pisa, 56126 Pisa, Italy;
- EndoCAS Center, Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, 56126 Pisa, Italy;
| | - Rosanna Maria Viglialoro
- EndoCAS Center, Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, 56126 Pisa, Italy;
| | - Sara Stagnari
- Department of Orthopaedics and Trauma Surgery, University of Pisa, 56100 Pisa, Italy; (S.S.); (M.S.); (P.D.P.)
| | - Sara Condino
- Department of Information Engineering, University of Pisa, 56126 Pisa, Italy;
- EndoCAS Center, Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, 56126 Pisa, Italy;
| | - Marco Gesi
- Center for Rehabilitative Medicine “Sport and Anatomy”, University of Pisa, 56121 Pisa, Italy;
- Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, 56126 Pisa, Italy
| | - Michelangelo Scaglione
- Department of Orthopaedics and Trauma Surgery, University of Pisa, 56100 Pisa, Italy; (S.S.); (M.S.); (P.D.P.)
| | - Paolo Domenico Parchi
- Department of Orthopaedics and Trauma Surgery, University of Pisa, 56100 Pisa, Italy; (S.S.); (M.S.); (P.D.P.)
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Crockatt WK, Confino JE, Kopydlowski NJ, Jobin CM, Levine WN. Comparing Skill Acquisition and Validity of Immersive Virtual Reality with Cadaver Laboratory Sessions in Training for Reverse Total Shoulder Arthroplasty. JB JS Open Access 2023; 8:e22.00141. [PMID: 37415724 PMCID: PMC10319363 DOI: 10.2106/jbjs.oa.22.00141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/08/2023] Open
Abstract
Immersive virtual reality (iVR) allows surgical trainees to practice skills without risking harm to patients or the need for cadaveric training resources. However, iVR has never been directly compared with cadaver training, the longtime gold standard for surgical skill training. We aimed to compare skill acquisition using cadaver laboratory and iVR training methods for augmented baseplate implantation during reverse total shoulder arthroplasty (rTSA). Methods In a randomized controlled trial, junior orthopaedic surgery residents were assigned to a 1-hour training with either iVR or a cadaveric laboratory session with shoulder specimens. Before training, all participants viewed an overview lecture and technique video demonstrating key steps of augmented baseplate implantation for rTSA. Participants were assessed by a blinded evaluator using validated competency checklists during cadaveric glenoid baseplate implantation. Continuous and categorial variables were analyzed using the 2-sample t test and Fisher exact test. Results Fourteen junior residents (3 incoming matched postgraduate year [PGY1], 6 PGY1s, 1 PGY2, and 4 PGY3s) were randomized to training with either iVR (n = 6) or cadaver laboratory (n = 8). There were no significant differences in demographic data, previous experience with rTSA, or previous use of iVR (p > 0.05). There were no significant difference in total Objective Structured Assessment of Technical Skill score (91.2% [15.2] vs. 93.25% [6.32], -0.1406 to 0.1823, p = 0.763), Global Rating Scale score (4.708 [0.459] vs. 4.609 [0.465], -0.647 to 0.450, p = 0.699), or time to completion (546 seconds [158] vs. 591 seconds [192], -176.3 to 266.8, p = 0.655) in cadaveric glenoid baseplate implantation. Average cost of iVR hardware and a 1-year software license was $4,900, and average cost of a single cadaver laboratory was $1,268.20 per resident. Conclusions Among junior orthopaedic residents, there is similar skill acquisition when training with either cadaver laboratory or iVR. Although additional research into this field is needed, iVR may provide an important and cost-effective tool in surgical education. Clinical Relevance Emerging simulation and iVR technology simulation in surgical training programs can increase access to effective and high-level surgical training across the globe and improve quality of care.
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Affiliation(s)
- William K. Crockatt
- NewYork-Presbyterian Hospital/Columbia University Irving Medical Center, New York, New York
| | - Jamie E. Confino
- NewYork-Presbyterian Hospital/Columbia University Irving Medical Center, New York, New York
| | - Nathan J. Kopydlowski
- NewYork-Presbyterian Hospital/Columbia University Irving Medical Center, New York, New York
| | - Charles M. Jobin
- NewYork-Presbyterian Hospital/Columbia University Irving Medical Center, New York, New York
| | - William N. Levine
- NewYork-Presbyterian Hospital/Columbia University Irving Medical Center, New York, New York
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Moretti L, Coviello M, Rosso F, Calafiore G, Monaco E, Berruto M, Solarino G. Current Trends in Knee Arthroplasty: Are Italian Surgeons Doing What Is Expected? MEDICINA (KAUNAS, LITHUANIA) 2022; 58:medicina58091164. [PMID: 36143840 PMCID: PMC9504315 DOI: 10.3390/medicina58091164] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Revised: 08/16/2022] [Accepted: 08/20/2022] [Indexed: 01/18/2023]
Abstract
Objectives: The purpose of this study is to evaluate Italian surgeons’ behavior during knee arthroplasty. Materials and Methods: All orthopedic surgeons who specialized in knee replacement surgeries and were members of the Italian Society of Knee, Arthroscopy, Sport, Cartilage and Orthopedic Technologies (SIGASCOT) between January 2019 and August 2019 were asked to complete a survey on the management of knee arthroplasty. Data were collected, analyzed, and presented as frequencies and percentages. Results: One-hundred and seventy-seven surgeons completed the survey and were included in the study. Ninety-five (53.7%) surgeons were under 40 years of age. Eighty-five surgeons (48%) worked in public hospitals and 112 (63.3%) were considered “high volume surgeons”, with more than 100 knee implants per year. Postero-stabilized total knee arthroplasty was the most commonly used, implanted with a fully cemented technique by 162 (91.5%) surgeons. Unicompartmental knee arthroplasty (UKA) was a rarer procedure compared to TKA, with 77% of surgeons performing less than 30% of UKAs. Most common TKA pre-operative radiological planning included complete antero-posterior (AP) weight-bearing lower limb radiographs, lateral view and patellofemoral view (used by 91%, 98.9% and 70.6% of surgeons, respectively). Pre-operative UKA radiological images included Rosenberg or Schuss views, patellofemoral view and magnetic resonance imaging (66.1%, 71.8% and 46.3% of surgeons, respectively). One hundred and thirty-two surgeons (74.6%) included an AP weight-bearing lower limb X-ray one year after surgery in the post-operative radiological follow-up. Furthermore, 119 surgeons (67.2%) did not perform a post-operative patellofemoral view because it was not considered useful for radiological follow-up. There was no uniformity in the timing and features of post-operative follow-up, with 13 different combinations. Conclusions: Italian surgeons perform TKA more commonly than UKA. Pre-operative TKA planning is quite uniform rather than UKA planning. Despite literature evidence, there is no agreement on follow-up. It may be useful to create a uniform checklist, including correct timing and exams needed. This analysis is also part of a society surgical educational project for training doctor.
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Affiliation(s)
- Lorenzo Moretti
- Orthopaedic and Trauma Unit, Department of Basic Medical Sciences, Neurscience and Sense Organs, School of Medicine, AOU Consorziale Policlinico, University of Bari “Aldo Moro”, Piazza Giulio Cesare 11, 70124 Bari, Italy
| | - Michele Coviello
- Orthopaedic and Trauma Unit, Department of Basic Medical Sciences, Neurscience and Sense Organs, School of Medicine, AOU Consorziale Policlinico, University of Bari “Aldo Moro”, Piazza Giulio Cesare 11, 70124 Bari, Italy
- Correspondence: ; Tel.: +39-3938165088
| | - Federica Rosso
- Ordine Mauriziano, Orthopaedics and Traumatology Department, Largo Turati 62, 10128 Turin, Italy
| | - Giuseppe Calafiore
- Department of Orthopaedic and Trauma Surgery, Città di Parma Clinic, Piazzale Athos Maestri 5, 43123 Parma, Italy
| | - Edoardo Monaco
- Orthopedic Unit, Kirk Kilgour Sports Injury Centre, S. Andrea Hospital, University of Rome Sapienza, 00189 Rome, Italy
| | - Massimo Berruto
- Chirurgia Articolare del Ginocchio, ASST Ospedale Gaetano Pini CTO, 20122 Milano, Italy
| | - Giuseppe Solarino
- Orthopaedic and Trauma Unit, Department of Basic Medical Sciences, Neurscience and Sense Organs, School of Medicine, AOU Consorziale Policlinico, University of Bari “Aldo Moro”, Piazza Giulio Cesare 11, 70124 Bari, Italy
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Trompeter A. Orthopaedic education: a COVID-driven evolution. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2021; 31:803-806. [PMID: 34117919 PMCID: PMC8196277 DOI: 10.1007/s00590-021-03009-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
Affiliation(s)
- Alex Trompeter
- Department of Trauma and Orthopaedics, St George's University Hospital, London, London, UK. .,St George's University of London, London, UK. .,EJOST, Paris, France.
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Xie XJ, Cao SL, Tong K, Zhong ZY, Wang G. Three-dimensional finite element analysis with different internal fixation methods through the anterior approach. World J Clin Cases 2021; 9:1814-1826. [PMID: 33748230 PMCID: PMC7953397 DOI: 10.12998/wjcc.v9.i8.1814] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Revised: 01/06/2021] [Accepted: 01/26/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND With the modernization of society and transportation in the last decades in China, the incidence of high-energy trauma increased sharply in China, including that of acetabular fractures.
AIM To establish different finite element models for acetabular posterior column fractures involving the quadrilateral area of the acetabulum.
METHODS The three-dimensional models of the normal and fractured pelvis and the five internal fixations were established using the computed tomography data of the pelvis of a living volunteer. After the vertebral body model was inserted in the way of origin matching and all cancellous bones were copied using the duplicated cancellous bone model as the subtractive entity, the Boolean operation was performed on the pelvis model to obtain the model of the complete pelvis cortical and cancellous bones.
RESULTS In the standing position, the maximum stress was 46.21 MPa. In the sitting position, the sacrum bore the simulated gravity load at the upper end. When comparing the five fixations, there were no significant differences in the stress mean values among groups (sitting: P = 0.9794; standing: P = 0.9741). In terms of displacement, the average displacement of the internal iliac plate group was smaller than that of the spring plate group (P = 0.002), and no differences were observed between the other pairs of groups (all P > 0.05). In the standing position, there were no significant differences in the mean value of displacement among the groups (P = 0.2985). It can be seen from the stress nephogram of the internal fixations in different positions that the stress of the internal fixation was mainly concentrated in the fracture segment.
CONCLUSION There were no significant differences among the fixations for acetabular posterior column fractures involving the quadrilateral area of the acetabulum.
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Affiliation(s)
- Xian-Jin Xie
- Department of Orthopaedic Surgery, Nanfang Hospital, Southern Medical University, Guangzhou 510515, Guangdong Province, China
| | - Sheng-Lu Cao
- Department of Orthopaedic Surgery, Nanfang Hospital, Southern Medical University, Guangzhou 510515, Guangdong Province, China
| | - Kai Tong
- Department of Orthopaedic Surgery, Zhongnan Hospital, Wuhan University, Wuhan 430000, Hubei Province, China
| | - Zi-Yi Zhong
- Department of Orthopaedic Surgery, Nanfang Hospital, Southern Medical University, Guangzhou 510515, Guangdong Province, China
| | - Gang Wang
- Department of Orthopaedic Surgery, Nanfang Hospital, Southern Medical University, Guangzhou 510515, Guangdong Province, China
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Chu AK, Law RW, Greschner JM, Hyer CF. Effectiveness of the Cadaver Lab in Podiatric Surgery Residency Programs. J Foot Ankle Surg 2021; 59:246-252. [PMID: 32130985 DOI: 10.1053/j.jfas.2019.08.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2019] [Accepted: 08/11/2019] [Indexed: 02/03/2023]
Abstract
Since the inception of the first surgical training system by Sir William Stewart Halsted, resident surgical skill development has been promulgated in teaching hospitals. Currently, the Council on Podiatric Medical Education does not mandate the availability of a cadaver lab as a residency curriculum requirement. The purpose of the present study is to assess the structure of the cadaver lab and availability in the current podiatric surgical training programs. A survey was sent electronically to 229 American Association of Colleges of Podiatric Medicine-approved residency programs, excluding OhioHealth, across all residency programs. A total of 173 (6.9%) residents from 74 (32.3%) residency programs completed the survey. This survey analyzed the characteristics and perception of the current state of cadaver lab in podiatric residency. The most reported type of cadaver labs available were medical company sponsored and hospital sponsored. Other hands-on training, including inanimate simulators (n = 24) and animal models (n = 5), was also reported. Overall, 87.9% of the surveyed residents found that cadaver lab is either extremely beneficial (57.8%) or somewhat beneficial (30.1%). The most important factors perceived in a successful cadaver lab were faculty instruction (n = 78), accessibility of lab (n = 46), and availability of instrumentation/hardware (n = 26). This qualitative survey is the first study to address the uniformity, perception, and potential value of the cadaver lab in a podiatric surgical residency.
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Affiliation(s)
- Anson K Chu
- Chief Resident, Grant Medical Center, Columbus, OH; Resident Physician, Grant Medical Center, Columbus, OH.
| | - Rona W Law
- Resident Physician, Grant Medical Center, Columbus, OH
| | | | - Christopher F Hyer
- Faculty, Grant Medical Center, Columbus, OH; Fellowship-Trained Foot and Ankle Surgeon, Orthopedic Foot and Ankle Center, Westerville, OH; Residency Program Director, Grant Medical Center, Columbus, OH
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Safely Implementing the Direct Anterior Total Hip Arthroplasty: A Methodological Approach to Minimizing the Learning Curve. J Am Acad Orthop Surg 2020; 28:930-936. [PMID: 32015249 DOI: 10.5435/jaaos-d-19-00752] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
INTRODUCTION Orthopaedic surgeons often cite concern for a learning curve as a barrier to adopting the direct anterior approach (DAA) for total hip arthroplasty (THA) while transitioning from other approaches. Studies both assessing and describing a practical approach and strategy to safely accomplish this transition, as well as the effect on clinical outcomes, are not well described. METHODS This prospective study compares a single surgeon's operative results and complications for the first consecutive 100 direct anterior THA to the last 100 consecutive posterior THA after 7 years in practice. The regimented and disciplined learning strategy used to implement the DAA is detailed in this study. The data were analyzed using univariate and multivariate regression models. RESULTS Univariate analyses identified significant differences in sex, age, Asian race, and diagnostic cause for THA between the two cohorts. Multivariate analyses controlled for these differences and showed that relative to posterior THA, direct anterior THA cases were associated with 7-minute longer procedures (P = 0.002) and lengths of stay that were 0.7 days fewer (P = 0.013). No significant differences were present in the estimated blood loss, and importantly, no significant differences in death or surgical complication rates between cohorts. DISCUSSION This study suggests that the DAA for THA can be safely implemented without the increased and adverse risk to the patient when a structured learning process is maintained and meticulously performed.
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Klima S, Cornwall J, Kieser D, Hammer N. The utility and benefit of a newly established postgraduate training course in surgical exposures for orthopedic and trauma surgery. Arch Orthop Trauma Surg 2019; 139:1673-1680. [PMID: 31041521 DOI: 10.1007/s00402-019-03189-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2019] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Limited data exist on specialty surgical cadaver courses for graduates, their skill gain, and whether the course contents are transferable to other surgical disciplines. AIM We present the details on the establishment of a specialist trauma and orthopedics approach course, and explore educational and career outcomes from this program. METHODS A 3-day surgical approach course was developed, including a dissection program utilizing Thiel embalmed cadavers. The course was accredited with the local orthopedics association. Participants were assessed by survey on acquired surgical knowledge, skill, decision-making, confidence, and on self-development and effect on career. RESULTS Thirty-one participants successfully completed the courses over 3 years. Increases in surgical skill, knowledge, surgical decision-making and confidence were reported. Skills and confidence also positively impacted on other surgical disciplines. Courses rated highly for learning outcomes; comments highlighted usefulness, applicability, and practicing opportunities, while also impacting positively on career opportunities. CONCLUSION Surgical courses have shown being useful for the acquisition of skills, knowledge, confidence and decision-making, with a positive impact on confidence and decision-making. This information is relevant to future participants, benefactors, surgical programs, and tertiary institutions who want to establish specialist surgical courses.
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Affiliation(s)
- Stefan Klima
- Department of Anatomy, University of Otago, Lindo Ferguson Building, 270 Great King St, Dunedin, 9016, New Zealand.,Department of Trauma, Orthopedic and Plastic Surgery, University Hospital of Leipzig, Leipzig, Germany.,Orthopedicus Clinics, Leipzig, Germany
| | - Jon Cornwall
- Center for Early Learning in Medicine, University of Otago, Dunedin, New Zealand
| | - David Kieser
- Department of Orthopedic Surgery and MSM, Christchurch Hospital, Christchurch, New Zealand
| | - Niels Hammer
- Department of Anatomy, University of Otago, Lindo Ferguson Building, 270 Great King St, Dunedin, 9016, New Zealand. .,Department of Trauma, Orthopedic and Plastic Surgery, University Hospital of Leipzig, Leipzig, Germany. .,Medical Division, Fraunhofer Institute for Machine Tools and Forming Technology, Dresden, Germany.
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van der Heijden LLM, Reijman M, van der Steen MCM, Janssen RPA, Tuijthof GJM. Validation of Simendo Knee Arthroscopy Virtual Reality Simulator. Arthroscopy 2019; 35:2385-2390. [PMID: 31053458 DOI: 10.1016/j.arthro.2019.01.031] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2018] [Revised: 01/16/2019] [Accepted: 01/18/2019] [Indexed: 02/02/2023]
Abstract
PURPOSE To determine the face and construct validity as well as educational value and user-friendliness of the Simendo knee arthroscopy virtual reality simulator. METHODS Sixty participants were recruited and equally divided into novices (0 arthroscopic procedures), intermediates (1-59 arthroscopic procedures), and experts (60 or more arthroscopic procedures). Participants were excluded if they had previously trained with the studied simulator. Construct validity, that is, the ability to discriminate between different levels of expertise, was examined by a navigation task. All participants were asked to perform 5 navigation trials within 10 minutes. Face validity, educational value, and user-friendliness were examined by questionnaires before and after the navigation trials. Face validity is the subjective impression of how closely the simulation replicates the real environment. RESULTS The novices were significantly slower than the intermediates in the first (P < .001) and the third (P = .031) trial. The novices were significantly slower than the experts in all trials (P = .016), except for the fifth (P = .054). The experts were significantly faster than the intermediates in every trial except for the fourth (P = .069). Median task time for the fifth trial was 63 seconds (44-80 seconds) for novices, 58 seconds (46-80 seconds) for intermediates, and 41 seconds (33-55 seconds) for experts. Ninety-two percent of all participants agreed that the simulator can be used to train for surgical inspection, and 95% indicated sufficient user-friendliness. CONCLUSIONS Based on the results, this knee simulator can be applied to train the basic arthroscopic hand-eye coordination skills at the start of resident education programs. Further testing is necessary to determine whether the skills are retained. CLINICAL RELEVANCE The simulator is partly validated, which contributes to training of basic arthroscopic skills without compromising patient safety.
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Affiliation(s)
| | - Max Reijman
- Department of Orthopedic Surgery and Trauma, Máxima Medical Center, Eindhoven, The Netherlands
| | | | - Rob P A Janssen
- Department of Orthopedic Surgery and Trauma, Máxima Medical Center, Eindhoven, The Netherlands
| | - Gabrielle J M Tuijthof
- Department of Orthopedic Surgery, Academic Center for Evidence Based Sports Medicine, Academic Medical Center, Amsterdam, The Netherlands; Research Centre Smart Devices, Zuyd University of Applied Sciences, Heerlen, The Netherlands
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Milano G. Postgraduate Training in Joint Surgery: The Role of Scientific Societies. JOINTS 2017; 5:195-196. [PMID: 29270554 PMCID: PMC5738477 DOI: 10.1055/s-0037-1615789] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
Affiliation(s)
- Giuseppe Milano
- Department of Orthopaedics, Catholic University, Rome, Italy.,Service of Shoulder Surgery, A. Gemelli University Hospital, Rome, Italy
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