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Gareb B, van Munster VDM, Dijkstra PU, Bos RRM, Vissink A, van Bakelen NB, van Minnen B. Reliability and accuracy of the torque applied to osteosynthesis screws by maxillofacial surgeons and residents. Sci Rep 2022; 12:14411. [PMID: 36002589 PMCID: PMC9402715 DOI: 10.1038/s41598-022-18687-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Accepted: 08/17/2022] [Indexed: 11/09/2022] Open
Abstract
Applying the right torque to osteosynthesis screws is important for undisturbed bone healing. This study aimed to compare test-retest and intra-individual reliabilities of the torque applied to 1.5 mm and 2.0 mm osteosynthesis screws by residents and oral and maxillofacial surgeons (OMF-surgeons), to define the reference torque intervals, and to compare reference torque interval compliances. Five experienced OMF-surgeons and 20 residents, 5 of each 4 residency years, were included. Each participant inserted six 1.5 × 4 mm and six 2.0 × 6 mm screws into a preclinical model at two test moments 2 weeks apart (T1 and T2). Participants were blinded for the applied torque. Descriptive statistics, reference intervals, and intra-class correlation coefficients (ICC) were calculated. The OMF-surgeons complied more to the reference intervals (1.5 mm screws: 95% and 2.0 mm screws: 100%) than the residents (82% and 90%, respectively; P = 0.009 and P = 0.007) with the ICCs ranging between 0.85-0.95 and 0.45-0.97, respectively. The residents' accuracy and reliability were inadequate regarding the 1.5 mm screws but both measures improved at T2 for both screw types compared to T1, indicating a learning effect. Training residents and/or verifying the applied torque by experienced OMF-surgeons remains necessary to achieve high accuracy and reliability, particularly for 1.5 mm screws.
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Affiliation(s)
- Barzi Gareb
- Department of Oral and Maxillofacial Surgery, University Medical Center Groningen, University of Groningen, Hanzeplein 1, 9713 GZ, P.O. Box 30001, 9700 RB, Groningen, The Netherlands.
| | - Valerie D M van Munster
- Department of Oral and Maxillofacial Surgery, University Medical Center Groningen, University of Groningen, Hanzeplein 1, 9713 GZ, P.O. Box 30001, 9700 RB, Groningen, The Netherlands
| | - Pieter U Dijkstra
- Department of Oral and Maxillofacial Surgery, University Medical Center Groningen, University of Groningen, Hanzeplein 1, 9713 GZ, P.O. Box 30001, 9700 RB, Groningen, The Netherlands.,Department of Rehabilitation Medicine, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Ruud R M Bos
- Department of Oral and Maxillofacial Surgery, University Medical Center Groningen, University of Groningen, Hanzeplein 1, 9713 GZ, P.O. Box 30001, 9700 RB, Groningen, The Netherlands
| | - Arjan Vissink
- Department of Oral and Maxillofacial Surgery, University Medical Center Groningen, University of Groningen, Hanzeplein 1, 9713 GZ, P.O. Box 30001, 9700 RB, Groningen, The Netherlands
| | - Nico B van Bakelen
- Department of Oral and Maxillofacial Surgery, University Medical Center Groningen, University of Groningen, Hanzeplein 1, 9713 GZ, P.O. Box 30001, 9700 RB, Groningen, The Netherlands
| | - Baucke van Minnen
- Department of Oral and Maxillofacial Surgery, University Medical Center Groningen, University of Groningen, Hanzeplein 1, 9713 GZ, P.O. Box 30001, 9700 RB, Groningen, The Netherlands
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Koper MC, Reijman M, van Es EM, Waarsing JH, Koot HWJ, Keizer SB, Jansen I, van Biezen FC, Verhaar JAN, Bos PK. No added value for Computer-Assisted surgery to improve femoral component positioning and Patient Reported Outcomes in Hip Resurfacing Arthroplasty; a multi-center randomized controlled trial. BMC Musculoskelet Disord 2019; 20:473. [PMID: 31651318 PMCID: PMC6814023 DOI: 10.1186/s12891-019-2883-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2019] [Accepted: 10/07/2019] [Indexed: 12/12/2022] Open
Abstract
Background Computer Assisted Surgery (CAS) has proven to improve the accuracy in several orthopedic procedures. Therefore we used this technique to evaluate femoral component positioning in Hip Resurfacing Arthroplasty (HRA). The aim of this study was to evaluate imageless CAS compared to manually implanted femoral components and subsequently evaluates Patient Related Outcome Measures (PROMs). We hypothesized that the use of CAS optimizes the position of the femoral component and improves PROMs. Methods This is a multicenter, single-blinded, randomized, controlled trial of two groups. In the CAS group guiding of the femoral component was done with imageless navigation. In the Conventional (control) group the femoral component was placed manually according to the preplanned position. The primary outcome measure consists of a maximum of 3 degrees difference between the postoperative Stem Shaft Angle (SSA) and preplanned SSA. Secondary outcome measures consist of the Hip disability and Osteoarthritis Outcome Scale (HOOS), the Harris Hip Score (HHS) and Visual Analogue Scale (VAS) pain score. Results A total of 122 patients were randomized, 61 in the CAS group and 61 in the conventional group. There was no significant differences in accuracy of femoral implant position. The mean difference between the postoperative- and preplanned SSA was − 2.26 and − 1.75 degrees (more varus) respectively in the CAS and Conventional group. After surgery both groups show significant improvement in all PROMs compared to the baseline measurements, with no significant differences between the groups. Conclusion Our cohort indicates no benefit for the use of CAS in accuracy of placement of the femoral component in HRA compared to manual implantation. There are no clinical differences in PROMs after 1 year follow up. This study showed no added value and no justification for the use of CAS in femoral component positioning in HRA. Trial registration This trial is registered at ClinicalTrails.gov (https://clinicaltrials.gov/) on the 25th of October 2006: NCT00391937. Level of incidence Level IIb, multicenter randomized controlled trial.
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Affiliation(s)
- M C Koper
- Department of Orthopedics, Erasmus University Medical Center, PO BOX 2040, 3000, CA, Rotterdam, The Netherlands.
| | - M Reijman
- Department of Orthopedics, Erasmus University Medical Center, PO BOX 2040, 3000, CA, Rotterdam, The Netherlands
| | - E M van Es
- Department of Orthopedics, Erasmus University Medical Center, PO BOX 2040, 3000, CA, Rotterdam, The Netherlands
| | - J H Waarsing
- Department of Orthopedics, Erasmus University Medical Center, PO BOX 2040, 3000, CA, Rotterdam, The Netherlands
| | - H W J Koot
- Department of Orthopedics, Maxima Medical Center, Eindhoven, The Netherlands
| | - S B Keizer
- Department of Orthopedics, Medical Center Haaglanden, Den Haag, The Netherlands
| | - I Jansen
- Department of Orthopedics, Admiraal de Ruyter Hospital, Goes, The Netherlands
| | - F C van Biezen
- Department of Orthopedics, Erasmus University Medical Center, PO BOX 2040, 3000, CA, Rotterdam, The Netherlands
| | - J A N Verhaar
- Department of Orthopedics, Erasmus University Medical Center, PO BOX 2040, 3000, CA, Rotterdam, The Netherlands
| | - P K Bos
- Department of Orthopedics, Erasmus University Medical Center, PO BOX 2040, 3000, CA, Rotterdam, The Netherlands
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Dubois L, Jansen J, Schreurs R, Habets PE, Reinartz SM, Gooris PJ, Becking AG. How reliable is the visual appraisal of a surgeon for diagnosing orbital fractures? J Craniomaxillofac Surg 2016; 44:1015-24. [DOI: 10.1016/j.jcms.2016.05.001] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2015] [Revised: 04/12/2016] [Accepted: 05/09/2016] [Indexed: 12/20/2022] Open
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