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Boere PM, Kachooei AR, Ilyas AM. Orthopaedic Hand Surgical Simulation Training: A Review. J Hand Microsurg 2024; 16:100024. [PMID: 38855522 PMCID: PMC11144645 DOI: 10.1055/s-0043-1762895] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/14/2023] Open
Abstract
In recent years, new orthopaedic surgical simulation and virtual reality (VR) training models have emerged to provide unlimited education medium to an unlimited number of trainees with no time limit, especially in response to trainee work-hour restrictions. Surgical simulators range from simple wooden boxes to animal and cadaver models to three-dimensional-printed and VR simulators. The coronavirus disease 2019 pandemic further highlighted the need for at-home learning tools for orthopaedic surgical trainees. Advancement in simulating shoulder and knee arthroscopies using VR simulators surpasses the other fields in orthopaedic surgery. Despite the high degree of precision needed to operate at a microscopic level involving vessels, nerves, and the small bones of the hand, the simulation tools have limited advancement in the field of orthopaedic hand surgery. This narrative review summarizes the status of surgical simulation and training techniques available to orthopaedic hand surgical trainees, factors affecting their application, and areas in hand surgery that still lag behind their surgical subspecialty counterparts.
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Affiliation(s)
- Payton M. Boere
- Department of Orthopaedics, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania, United States
| | - Amir R. Kachooei
- Rothman Orthopaedic Institute, Thomas Jefferson University, Philadelphia, Pennsylvania, United States
| | - Asif M. Ilyas
- Rothman Orthopaedic Institute, Thomas Jefferson University, Philadelphia, Pennsylvania, United States
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SONI JAMIL, GAMBA LUIZEKREMER, BEBBER FABIANADESOUZA, KOZOVITS FRANCISCO. DEVELOPMENT OF ORTHOPEDIC SIMULATOR TO PRACTICE CLOSED REDUCTION OF PEDIATRIC FRACTURES OF THE MIDDLE THIRD OF FOREARM. ACTA ORTOPEDICA BRASILEIRA 2023; 31:e252387. [PMID: 36844128 PMCID: PMC9949289 DOI: 10.1590/1413-785220233101e252387] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Accepted: 03/23/2022] [Indexed: 02/22/2023]
Abstract
In the current scenario of medical education, a trend of using models and simulators to train operational skills, especially in the practice of basic orthopedic techniques, is growing. This form of teaching allows academics to maximize learning opportunities and contributes to improving the quality of care for their future patients. However, the realistic simulation has high costs as a major limitation. Objective To develop a low-cost orthopedic simulator for practicing pediatric forearm reduction skills in the preclinical setting. Methods A model of an arm and forearm with a fracture in the middle third was developed. Orthopedists, residents, and medical students evaluated the simulator's ability to reproduce fracture reduction. Results The simulator had a significantly lower cost than the others in the literature. The participants agreed that the model had a good performance, and that the manipulation was consistent with the reality of reducing closed pediatric forearm fracture. Conclusion The results suggest that this model can be used to teach orthopedic residents and medical students the skill of closed reduction of fractures in the middle third of the forearm. Level of Evidence III, Case Control Study.
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Affiliation(s)
- JAMIL SONI
- Pontifícia Universidade Católica do Paraná, School of Medicine, Curitiba, PR, Brasil
| | - LUIZE KREMER GAMBA
- Pontifícia Universidade Católica do Paraná, School of Medicine, Curitiba, PR, Brasil
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Olson N, Griggs J, Balhara KS, Kann K, April MD, Olson AS. Evaluation of a Hands-On Wrist Fracture Simulator for Fracture Management Training in Emergency Medicine Residents. Cureus 2022; 14:e27030. [PMID: 35989857 PMCID: PMC9388193 DOI: 10.7759/cureus.27030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/27/2022] [Indexed: 11/05/2022] Open
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Ikwuezunma IA, Guilbault R, Jain A, Lee RJ, Varghese R, Lentz JM, Sponseller PD, LaPorte D, Margalit A. Development and Validation of SCFE Percutaneous Pinning Surgical Simulation. J Pediatr Orthop 2022; 42:e577-e582. [PMID: 35319527 DOI: 10.1097/bpo.0000000000002142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND In situ screw fixation with a single percutaneously placed femoral screw remains widely accepted for femoral head fixation in adolescent patients with slipped capital femoral epiphysis (SCFE). Given the potential risks involved with this procedure, a simulation whereby surgical skills could be refined before entering the operating room may be of benefit to orthopaedic trainees. METHODS We developed a synthetic model for the simulated treatment of SCFE. Five orthopaedic attendings and twenty trainees were recorded performing an in situ percutaneous fixation on the SCFE model. Time, radiation exposure, and final anteroposterior and lateral radiographs of the SCFE model were recorded. After completion, the attendings and trainees answered a Likert-based questionnaire regarding the realism and utility of the simulation, respectively. Two blinded orthopaedic surgeons rated each participant's skill level based on previously described assessment tools, including a Global Rating Scale (GRS) of technical proficiency and radiographic grading index for screw placement. Performance metrics and survey responses were evaluated for construct validity, face validity, and interrater reliability. RESULTS The attendings demonstrated superior technical proficiency compared with trainees in terms of higher GRS scores (27.9±1.9 vs. 14.7±5.0, P<0.001) and better radiographic grading of screw placement on lateral views (P=0.019). Similarly, compared with the trainees, the orthopaedic attendings demonstrated shorter operative times (11.0±4.1 vs. 14.7±6.2 min, P=0.035) and less radiation exposure (3.7±1.7 vs. 9.5±5.7 mGy, P=0.037). The interrater reliability was excellent for both the GRS scoring (intraclass correlation coefficient=0.973) and radiographic grading (weighted κ=1.000). The attendings and trainees rated the realism and teaching utility of the simulation as "very good," respectively. CONCLUSION Our surgical simulation for in situ percutaneous fixation of SCFE represents a valid and reliable measure of technical competency and demonstrates much promise for potential use as a formative educational tool for orthopaedic residency programs. LEVEL OF EVIDENCE Level II.
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Affiliation(s)
- Ijezie A Ikwuezunma
- Department of Orthopaedic Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD
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Heskin L, Galvin R, Traynor O, Simms C. Simulation in Upper and Lower Limb Trauma Skill Acquisition: A Review. Simul Healthc 2022; 17:54-65. [PMID: 34009908 DOI: 10.1097/sih.0000000000000570] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
SUMMARY STATEMENT This review aimed to explore the published evidence with regard to the types and composition of both full- and part-task trainers to teach surgeons extremity exploration procedures in limb trauma management. Studies were included if they reported the development and/or validation of synthetic or virtual task trainers. Studies were evaluated to determine their derivation, usability, and clinical utility.A total of 638 citations were identified and 63 satisfied the inclusion criteria. Twenty-five articles addressed simulator validation and 36 addressed level of learning achieved with simulator engagement. Two studies described a dedicated limb simulator. Simulators were developed to repair limb structures including skin (n = 15), tendon (n = 7), nerve (n = 1), fascia (n = 1), muscle (n = 1), vascular (n = 24), and bone (n = 11). Considerations such as material fidelity, learning outcomes, cost or reusability, validity, and effectiveness are inconsistently reported. Future studies should address design standards for the effective production of synthetic or virtual simulators for limb trauma management.
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Affiliation(s)
- Leonie Heskin
- From the Department of Surgical Affairs, Royal College of Surgeons in Ireland (L.H., O.T.); University of Limerick (R.G.); and Trinity College Dublin (C.S.), Dublin, Ireland
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Costa ML, Achten J, Ooms A, Png ME, Cook JA, Lamb SE, Hedley H, Dias J. Surgical fixation with K-wires versus casting in adults with fracture of distal radius: DRAFFT2 multicentre randomised clinical trial. BMJ 2022; 376:e068041. [PMID: 35045969 PMCID: PMC8767805 DOI: 10.1136/bmj-2021-068041] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
OBJECTIVE To assess wrist function, quality of life, and complications in adult patients with a dorsally displaced fracture of the distal radius, treated with either a moulded cast or surgical fixation with K-wires. DESIGN Multicentre randomised clinical superiority trial, SETTING: 36 hospitals in the UK National Health Service (NHS). PARTICIPANTS 500 adults aged 16 or over with a dorsally displaced fracture of the distal radius, randomised after manipulation of their fracture (255 to moulded cast; 245 to surgical fixation). INTERVENTIONS Manipulation and moulded cast was compared with manipulation and surgical fixation with K-wires plus cast. Details of the application of the cast and the insertion of the K-wires were at the discretion of the treating surgeon, according to their normal clinical practice. MAIN OUTCOME MEASURES The primary outcome measure was the Patient Rated Wrist Evaluation (PRWE) score at 12 months (five questions about pain and 10 about function and disability; overall score out of 100 (best score=0 and worst score=100)). Secondary outcomes were PRWE score at three and six months, quality of life, and complications, including the need for surgery due to loss of fracture position in the first six weeks. RESULTS The mean age of participants was 60 years and 417 (83%) were women; 395 (79%) completed follow-up. No statistically significant difference in the PRWE score was seen at 12 months (cast group (n=200), mean 21.2 (SD 23.1); K-wire group (n=195), mean 20.7 (22.3); adjusted mean difference -0.34 (95% confidence interval -4.33 to 3.66), P=0.87). No difference was seen at earlier time points. In the cast group, 33 (13%) of participants needed surgical fixation for loss of fracture position in the first six weeks compared with one revision surgery in the K-wire group (odds ratio 0.02, 95% confidence interval 0.001 to 0.10). CONCLUSIONS Among patients with a dorsally displaced distal radius fracture that needed manipulation, surgical fixation with K-wires did not improve patients' wrist function at 12 months compared with a cast. TRIAL REGISTRATION ISRCTN registry ISRCTN11980540.
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Affiliation(s)
- Matthew L Costa
- Oxford Trauma and Emergency Care, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Trauma Unit, Kadoorie Centre, John Radcliffe Hospital, Oxford, UK
| | - Juul Achten
- Oxford Trauma and Emergency Care, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Trauma Unit, Kadoorie Centre, John Radcliffe Hospital, Oxford, UK
| | - Alexander Ooms
- Oxford Clinical Trials Research Unit, Centre for Statistics in Medicine, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Botnar Research Centre, Oxford, UK
| | - May Ee Png
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Radcliffe Primary Care Building, Oxford, UK
| | - Jonathan A Cook
- Oxford Clinical Trials Research Unit, Centre for Statistics in Medicine, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Botnar Research Centre, Oxford, UK
| | - Sarah E Lamb
- College of Medicine and Health, South Cloisters, University of Exeter, Exeter, UK
| | - Helen Hedley
- Department of Trauma and Orthopaedics, University Hospital Coventry and Warwickshire NHS Trust, University Hospital Coventry and Warwickshire, Coventry, UK
| | - Joseph Dias
- Department of Health Sciences, University of Leicester, George Davies Centre, Leicester, UK
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Liu P, Xiao JX, Zhao C, Li X, Sun G, Yang F, Wang X. Factors Associated With the Accuracy of Depth Gauge Measurements. Front Surg 2022; 8:774682. [PMID: 35096957 PMCID: PMC8793061 DOI: 10.3389/fsurg.2021.774682] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2021] [Accepted: 12/20/2021] [Indexed: 11/13/2022] Open
Abstract
Background: It is important to select appropriate screws in orthopedic surgeries, as excessively long or too short a screw may results failure of the surgeries. This study explored factors that affect the accuracy of measurements in terms of the experience of the surgeons, passage of drilled holes and different depth gauges.Methods: Holes were drilled into fresh porcine femurs with skin in three passages, straight drilling through the metaphysis, straight drilling through the diaphysis, and angled drilling through the diaphysis. Surgeons with different surgical experiences measured the holes with the same depth gauge and using a vernier caliper as gold standard. The length of selected screws, and the time each surgeon spent were recorded. The measurement accuracy was compared based on the experiences of the surgeons and the passage of drilled holes. Further, parameters of depth gauges and 12-mm cortical bone screws from five different manufacturers were measured.Results: A total of 13 surgeons participated in 585 measurements in this study, and each surgeon completed 45 measurements. For the surgeons in the senior, intermediate, and junior groups, the average time spent in measurements was 689, 833, and 785 s with an accuracy of 57.0, 42.2, and 31.5%, respectively. The accuracy and measurement efficiency were significantly different among the groups of surgeons (P < 0.001). The accuracy of measurements was 45.1% for straight metaphyseal drilling, 43.6% for straight diaphyseal drilling, and 33.3% for angled diaphyseal drilling (P = 0.036). Parameters of depth gauges and screws varied among different manufacturers.Conclusion: Both observer factor and objective factors could affect the accuracy of depth gauge measurement. Increased surgeon's experience was associated with improvements in the accuracy rate and measurement efficiency of drilled holes based on the depth gauge. The accuracy rate varied with hole passages, being the lowest for angled drilled holes.
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Affiliation(s)
- Pengcheng Liu
- Shanghai Key Laboratory of Orthopedic Implant, Department of Orthopedics, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Joanna Xi Xiao
- School of Clinical Medicine, The National University of Ireland Galway, Galway, Ireland
| | - Chen Zhao
- Shanghai Key Laboratory of Orthopedic Implant, Department of Orthopedics, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Xiaodong Li
- Shanghai Key Laboratory of Orthopedic Implant, Department of Orthopedics, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Guantong Sun
- Shanghai Key Laboratory of Orthopedic Implant, Department of Orthopedics, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Fei Yang
- Shanghai Key Laboratory of Orthopedic Implant, Department of Orthopedics, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Xiaoqing Wang
- Shanghai Key Laboratory of Orthopedic Implant, Department of Orthopedics, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- *Correspondence: Xiaoqing Wang
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Pearl MC, Madariaga MC, Blum C, Lynch B, Komatsu DE, Barsi J. Clubfoot Cast Simulation Using Pressure Sensors: A Novel Way to Teach the Ponseti Method. JOURNAL OF SURGICAL EDUCATION 2022; 79:237-242. [PMID: 34538763 DOI: 10.1016/j.jsurg.2021.08.019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Revised: 05/25/2021] [Accepted: 08/22/2021] [Indexed: 06/13/2023]
Abstract
OBJECTIVE The standard of care in treating congenital clubfoot is the Ponseti method. Resident education of this skill traditionally involves direct casting of patients with attending feedback. With increased clinical time demands, mastery of the skill may not be achievable using direct resident - patient interactions. We describe a novel Ponseti cast simulator using pressure sensors to teach this skill. DESIGN A novel Ponseti cast simulator was constructed using a standardized model and pressure sensors. A pre-training baseline (trial 1) and post education (trial 2) was made and scored using an objective structured assessment of technical skill (OSATS) checklist. Pressure sensors were placed at the first metatarsal and talar head to record cast forces. SETTING The study was performed in the Department of Orthopedic Surgery at an academic tertiary care hospital. PARTICIPANTS Study participants included 6 junior orthopedic residents defined as post-graduate year (PGY) 1 to 3, 6 senior orthopedic residents (PGY 4,5), and a board -certified pediatric orthopedic surgeon to serve as a control. RESULTS Trial 1 OSATS scores were significantly higher in senior residents (9.7 ± 1.5) than junior residents (5.2 ± 1.2) (p = 0.004). Trial 2 OSATS scores were also significantly higher in senior residents than junior residents: 13.7 ± 1.4 vs. 5.8 ± 1.6 (p = 0.003). Additionally, senior residents significantly improved scores between the first 2 trials 9.7 ± 1.5 vs. 13.7 ± 1.4 (p = 0.003), while junior residents did not 5.2 ± 1.2 vs. 5.8 ± 1.6 (p = 0.4566). In addition, there were no significant differences between junior, and senior resident Trial 1 talar head pressures or first metatarsal pressures, or Trial 2 first metatarsal pressures. CONCLUSIONS This is the first casting simulation model to use pressure sensors as a way to objectively measure cast application pressure. This simulator may be useful in an orthopedic training programs to teach Ponseti casting.
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Affiliation(s)
| | | | | | - Brian Lynch
- Stony Brook University, Stony Brook, New York
| | | | - James Barsi
- Stony Brook University, Stony Brook, New York.
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Toal GG, Gisondi MA, Miller NM, Sebok-Syer SS, Avedian RS, Dixon WW. Simulation-Based Mastery Learning to Teach Distal Radius Fracture Reduction. Simul Healthc 2021; 16:e176-e180. [PMID: 33337726 DOI: 10.1097/sih.0000000000000534] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Distal radius fractures are common orthopedic injuries managed in emergency departments. Simulation-based mastery learning is widely recognized to improve provider competence for bedside procedures but has not been studied to teach fracture management. This study evaluated the effectiveness of a simulation-based mastery learning curriculum to teach distal radius fracture reduction to novice orthopedic surgery and emergency medicine residents. METHODS We created a novel mastery learning checklist using the Mastery Angoff method of standard setting, paired with a new simulation model designed for this project, to teach orthopedic surgery and emergency medicine interns (N = 22) at the study site. Orthopedic surgery and emergency medicine faculty members participated in checklist development, curriculum design, and implementation. Training included just-in-time asynchronous education with a readiness assessment test, in-classroom expert demonstration, and deliberate practice with feedback. Residents completed a pretest/posttest skills examination and a presurvey/postsurvey assessing procedural confidence. RESULTS Standard setting resulted in a 41-item checklist with minimum passing score of 37/41 items. All participants met or surpassed the minimum passing score on postexamination. Postsurvey confidence levels were significantly higher than presurvey in all aspects of the distal radius fracture procedure (P < 0.05). CONCLUSIONS This study demonstrated that a simulation-based mastery learning curriculum improved skills and confidence performing distal radius fracture reductions for orthopedic surgery and emergency medicine interns. Future planned studies include curriculum testing across additional institutions, examination of clinical impact, and application of mastery learning for other orthopedic procedures.
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Affiliation(s)
- Georgia G Toal
- From the Stanford University, School of Medicine (G.G.T.); Department of Emergency Medicine (M.A.G., S.S.S.-S., W.W.D.), Stanford University, Stanford, CA; Department of Emergency Medicine (N.M.M.), Vanderbilt University, Nashville, TN; and Department of Orthopedic Surgery (R.S.A.), Stanford University, Stanford, CA
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Oka K, Shiode R, Yoshii Y, Tanaka H, Iwahashi T, Murase T. Artificial intelligence to diagnosis distal radius fracture using biplane plain X-rays. J Orthop Surg Res 2021; 16:694. [PMID: 34823550 PMCID: PMC8620959 DOI: 10.1186/s13018-021-02845-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Accepted: 11/15/2021] [Indexed: 11/13/2022] Open
Abstract
Background Although the automatic diagnosis of fractures using artificial intelligence (AI) has recently been reported to be more accurate than those by orthopedics specialists, big data with at least 1000 images or more are required for deep learning of the convolutional neural network (CNN) to improve diagnostic accuracy. The aim of this study was to develop an AI system capable of diagnosing distal radius fractures with high accuracy even when learning with relatively small data by learning to use bi-planar X-rays images. Methods VGG16, a learned image recognition model, was used as the CNN. It was modified into a network with two output layers to identify the fractures in plain X-ray images. We augmented 369 plain X-ray anteroposterior images and 360 lateral images of distal radius fractures, as well as 129 anteroposterior images and 125 lateral images of normal wrists to conduct training and diagnostic tests. Similarly, diagnostic tests for fractures of the styloid process of the ulna were conducted using 189 plain X-ray anteroposterior images of fractures and 302 images of the normal styloid process. The distal radius fracture is determined by entering an anteroposterior image of the wrist for testing into the trained AI. If it identifies a fracture, it is diagnosed as the same. However, if the anteroposterior image is determined as normal, the lateral image of the same patient is entered. If a fracture is identified, the final diagnosis is fracture; if the lateral image is identified as normal, the final diagnosis is normal. Results The diagnostic accuracy of distal radius fractures and fractures of the styloid process of the ulna were 98.0 ± 1.6% and 91.1 ± 2.5%, respectively. The areas under the receiver operating characteristic curve were 0.991 {n = 540; 95% confidence interval (CI), 0.984–0.999} and 0.956 (n = 450; 95% CI 0.938–0.973). Conclusions Our method resulted in a good diagnostic rate, even when using a relatively small amount of data.
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Affiliation(s)
- Kunihiro Oka
- Department of Orthopaedic Surgery, Graduate School of Medicine, Osaka University, 2-2 Yamada-oka, Suita, Osaka, 565-0871, Japan.
| | - Ryoya Shiode
- Department of Orthopaedic Surgery, Graduate School of Medicine, Osaka University, 2-2 Yamada-oka, Suita, Osaka, 565-0871, Japan
| | - Yuichi Yoshii
- Ibaraki Medical Center, Department of Orthopaedic Surgery, Tokyo Medical University, 3-20-1 Chuo, Ami, Inashiki, Ibaraki, 300-0395, Japan
| | - Hiroyuki Tanaka
- Department of Orthopaedic Surgery, Graduate School of Medicine, Osaka University, 2-2 Yamada-oka, Suita, Osaka, 565-0871, Japan
| | - Toru Iwahashi
- Department of Orthopaedic Surgery, Graduate School of Medicine, Osaka University, 2-2 Yamada-oka, Suita, Osaka, 565-0871, Japan
| | - Tsuyoshi Murase
- Department of Orthopaedic Surgery, Graduate School of Medicine, Osaka University, 2-2 Yamada-oka, Suita, Osaka, 565-0871, Japan
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Rabinovich RV, Shore BJ, Glotzbecker M, Kalish LA, Bae DS. The Effect of Casting Simulation on Maintenance of Fracture Alignment Following Closed Reduction of Pediatric Distal Radius Fractures: Does More Simulation Matter? JOURNAL OF SURGICAL EDUCATION 2021; 78:1717-1724. [PMID: 33896733 DOI: 10.1016/j.jsurg.2021.03.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/21/2020] [Revised: 01/12/2021] [Accepted: 03/13/2021] [Indexed: 06/12/2023]
Abstract
BACKGROUND The purpose of this study was to evaluate the effectiveness of a simulation curriculum on performance of closed reduction (CR) and casting of distal radius and distal both-bone forearm fractures by orthopaedic surgery residents. The secondary aim was to identify if repeated simulation training during the clinical rotation provided additional benefit. METHODS Orthopaedic surgery residents performed simulated distal radius fracture (DRF) reduction and cast application near the beginning and end of their 6-month pediatric orthopaedic clinical rotation at a tertiary care children's hospital. A subgroup of trainees were randomly assigned additional simulation training halfway through their rotation. Clinically, 28 residents treated 159 distal radius and/or distal both-bone forearm fractures with CR and casting during the study period. Radiographic evaluations were performed comparing postreduction fracture angulation, displacement, cast index, and loss of reduction (LOR) rates at the beginning of a resident's rotation (presimulation cases) and at the end of the resident's rotation (postsimulation cases). Comparisons were also made between residents who had and did not have additional simulation training exposure during their rotation. RESULTS Overall, postreduction radius angulation, maximal angulation, and cast index were lower in the postsimulation group than in the presimulation group with means 1.8°, 2.6°, and 0.75 vs 4.0°, 4.4° and 0.77, respectively. LOR rate was also lower (14% vs 30%). No significant differences were demonstrated for postreduction ulna angulation as well as for radius, ulna, or maximal displacement between these 2 groups. No significant differences were observed in radiographic parameters, cast indices, or LOR rates between residents who underwent additional mid-rotation training vs those who did not. CONCLUSIONS The incorporation of a simulation training curriculum for CR and casting of pediatric distal forearm fractures resulted in statistically significant, however, marginally improved postreduction radiographic parameters and LOR rates among orthopaedic residents. The utility of repeated additional simulation training during the course of a clinical rotation remains unclear in the short term.
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Affiliation(s)
- Remy V Rabinovich
- Department of Orthopaedic Surgery, Lenox Hill Hospital, New York, New York; Department of Orthopaedic Surgery, Boston Children's Hospital, Boston, Massachusetts.
| | - Benjamin J Shore
- Department of Orthopaedic Surgery, Boston Children's Hospital, Boston, Massachusetts
| | - Michael Glotzbecker
- Department of Orthopaedic Surgery, Boston Children's Hospital, Boston, Massachusetts
| | - Leslie A Kalish
- Institutional Centers for Clinical and Translational Research, Boston Children's Hospital, Boston, Massachusetts
| | - Donald S Bae
- Department of Orthopaedic Surgery, Boston Children's Hospital, Boston, Massachusetts
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James HK, Chapman AW, Pattison GTR, Fisher JD, Griffin DR. Analysis of Tools Used in Assessing Technical Skills and Operative Competence in Trauma and Orthopaedic Surgical Training: A Systematic Review. JBJS Rev 2021; 8:e1900167. [PMID: 33006464 PMCID: PMC7360100 DOI: 10.2106/jbjs.rvw.19.00167] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
BACKGROUND Robust assessment of skills acquisition and surgical performance during training is vital to ensuring operative competence among orthopaedic surgeons. A move to competency-based surgical training requires the use of tools that can assess surgical skills objectively and systematically. The aim of this systematic review was to describe the evidence for the utility of assessment tools used in evaluating operative performance in trauma and orthopaedic surgical training. METHODS We performed a comprehensive literature search of MEDLINE, Embase, and Google Scholar databases to June 2019. From eligible studies we abstracted data on study aim, assessment format (live theater or simulated setting), skills assessed, and tools or metrics used to assess surgical performance. The strengths, limitations, and psychometric properties of the assessment tools are reported on the basis of previously defined utility criteria. RESULTS One hundred and five studies published between 1990 and 2019 were included. Forty-two studies involved open orthopaedic surgical procedures, and 63 involved arthroscopy. The majority (85%) were used in the simulated environment. There was wide variation in the type of assessment tools in used, the strengths and weaknesses of which are assessor and setting-dependent. CONCLUSIONS Current technical skills-assessment tools in trauma and orthopaedic surgery are largely procedure-specific and limited to research use in the simulated environment. An objective technical skills-assessment tool that is suitable for use in the live operative theater requires development and validation, to ensure proper competency-based assessment of surgical performance and readiness for unsupervised clinical practice. CLINICAL RELEVANCE Trainers and trainees can gain further insight into the technical skills assessment tools that they use in practice through the utility evidence provided.
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Affiliation(s)
- Hannah K James
- 1Clinical Trials Unit, Warwick Medical School, Coventry, United Kingdom 2Department of Trauma & Orthopedic Surgery, University Hospitals Coventry & Warwickshire, Coventry, United Kingdom
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Dixon W, Miller N, Toal GG, Sebok-Syer SS, Gisondi MA. Development of a 3D printed simulator for closed reduction of distal radius fractures. PERSPECTIVES ON MEDICAL EDUCATION 2021; 10:192-195. [PMID: 32989709 PMCID: PMC8187689 DOI: 10.1007/s40037-020-00609-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
BACKGROUND The use of simulators in medical education is critical for developing procedural competence prior to treating patients. Current training of emergency physicians to perform distal radius fracture reduction is inconsistent and inadequate. APPROACH We developed a 3D printed distal radius fracture simulation training model that is easy to assemble and relatively inexpensive. We present step-by-step instructions to reproduce the model. EVALUATION The model was found to have high fidelity for training by both instructors and participants in a simulation-based mastery learning course. REFLECTION We successfully designed a low cost, easy to reproduce, high fidelity model for use in a simulation-based mastery learning course to teach distal radius fracture reduction.
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Affiliation(s)
- William Dixon
- Department of Emergency Medicine, Stanford University, Stanford, CA, USA.
| | - Nathaniel Miller
- Department of Emergency Medicine, Vanderbilt University, Nashville, TN, USA
| | | | | | - Michael A Gisondi
- Department of Emergency Medicine, Stanford University, Stanford, CA, USA
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McKnight RR, Pean CA, Buck JS, Hwang JS, Hsu JR, Pierrie SN. Virtual Reality and Augmented Reality-Translating Surgical Training into Surgical Technique. Curr Rev Musculoskelet Med 2020; 13:663-674. [PMID: 32779019 PMCID: PMC7661680 DOI: 10.1007/s12178-020-09667-3] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
PURPOSE OF REVIEW As immersive learning outside of the operating room is increasingly recognized as a valuable method of surgical training, virtual reality (VR) and augmented reality (AR) are increasingly utilized in orthopedic surgical training. This article reviews the evolving nature of these training tools and provides examples of their use and efficacy. The practical and ethical implications of incorporating this technology and its impact on both orthopedic surgeons and their patients are also discussed. RECENT FINDINGS Head-mounted displays (HMDs) represent a possible adjunct to surgical accuracy and education. While the hardware is advanced, there is still much work to be done in developing software that allows for seamless, reliable, useful integration into clinical practice and training. Surgical training is changing: AR and VR will become mainstays of future training efforts. More evidence is needed to determine which training technology translates to improved clinical performance. Volatility within the HMD industry will likely delay advances in surgical training.
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Affiliation(s)
- R Randall McKnight
- Department of Orthopaedic Surgery, Atrium Health Musculoskeletal Institute, 1001 Blythe Blvd, Charlotte, NC, 28203, USA.
| | - Christian A Pean
- Department of Orthopedic Surgery, NYU Langone Health, New York, NY, USA
| | - J Stewart Buck
- Department of Orthopaedic Surgery, Atrium Health Musculoskeletal Institute, 1001 Blythe Blvd, Charlotte, NC, 28203, USA
| | - John S Hwang
- Department of Orthopedic Surgery, Mount Carmel, Columbus, OH, USA
- Department of Orthopedic Surgery, Orthopedic ONE, Columbus, OH, USA
| | - Joseph R Hsu
- Department of Orthopaedic Surgery, Atrium Health Musculoskeletal Institute, 1001 Blythe Blvd, Charlotte, NC, 28203, USA
| | - Sarah N Pierrie
- Department of Orthopaedics and Center for the Intrepid, San Antonio Military Medical Center, Fort Sam Houston, TX, USA
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A Single Education Session of Orthopaedic Residents Does Not Reduce The Rate of Failed Nonoperative Management or Improve Radiographic Outcomes in Pediatric Distal Radius Fractures. JOURNAL OF THE AMERICAN ACADEMY OF ORTHOPAEDIC SURGEONS GLOBAL RESEARCH AND REVIEWS 2020; 4:e20.00170. [PMID: 33986207 PMCID: PMC7575193 DOI: 10.5435/jaaosglobal-d-20-00170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/21/2020] [Accepted: 08/27/2020] [Indexed: 11/24/2022]
Abstract
Introduction: The primary objective was to evaluate whether a single educational session on casting is sufficient to reduce the rate of loss of reduction in pediatric distal radius fractures. Methods: A retrospective review was conducted of pediatric patients with distal radius fractures casted between November 2016 and February 2019. Patients were divided into two groups: those casted by a resident who participated in a targeted education session on short arm casting and those who had not. Results: A total of 137 patients were included (education cohort: 61 patients and noneducation cohort: 76 patients). The two groups demonstrated similar ages and pre/post-reduction radiographic measurements. In the education cohort, 11.5% required repeat casting, wedging, or surgical intervention versus 17.1% of patients in the noneducation cohort (P = 0.47). Patients casted by residents doing one of their first three independent casts trended toward being more likely to place a cast with poor cast index and to lose reduction (P = 0.12 and P = 0.43, respectively). Discussion: A one hour education session did not reduce the need for intervention or loss of reduction. For educating residents on the skill of casting to be effective, one may consider formal feedback and evaluation throughout multiple education sessions and in early episodes of clinical care. Level of Evidence: A Level III, Retrospective Comparative Study
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Abstract
Orthopaedic residency training has and will continue to evolve with a wide variety of changes. Hands-on surgical simulation "boot camps," computerized simulation of surgical process, and even virtual reality simulators, all can help trainees acquire surgical experience without compromising patient care. Low-cost training modules help remedy the rising costs associated with teaching complex orthopaedic surgery skills. Motion tracking and checklists help refine standardization of assessment. As technology and healthcare systems continue to grow, we encourage training programs to keep pace by considering engagement of these tools.
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Vaidya A, Aydin A, Ridgley J, Raison N, Dasgupta P, Ahmed K. Current Status of Technical Skills Assessment Tools in Surgery: A Systematic Review. J Surg Res 2020; 246:342-378. [DOI: 10.1016/j.jss.2019.09.006] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2019] [Revised: 08/29/2019] [Accepted: 09/11/2019] [Indexed: 12/18/2022]
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Simulation Training of Orthopaedic Residents for Distal Radius Fracture Reductions Improves Radiographic Outcomes. J Pediatr Orthop 2020; 40:e6-e13. [PMID: 30969197 DOI: 10.1097/bpo.0000000000001387] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Most distal radius fractures can be treated with closed reduction and casting in pediatric patients. These skills are traditionally developed treating real patients, however, there is growing interest in the use of simulation training to supplement traditional learning strategies. METHODS Seventy-eight children with distal radius fractures that underwent closed reduction and casting by novice orthopaedic surgery residents were retrospectively reviewed. Radiographic measures of patients treated by simulation-trained residents were compared with patients treated by residents without simulation training. RESULTS Patients treated by simulation-trained residents had less residual angulation in the anteroposterior radiograph (3.7 vs. 6.3 degrees, P=0.006) and translation on the lateral (14% vs. 21%, P=0.040) and anteroposterior radiograph (10% vs. 16%, P=0.029). Patients treated by simulation-trained residents also had lower rates of redisplacement (50% vs. 79%, P=0.016). CONCLUSIONS Loss of reduction is common, particularly when novice trainees perform their first independent reductions. Residents who underwent simulation training had lower rates of loss of reduction, thus simulation training has potential as a supplement to the traditional apprentice model of medical education. LEVEL OF EVIDENCE Level III.
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Schneider P, Bransford R, Harvey E, Agel J. Operative treatment of displaced midshaft clavicle fractures: has randomised control trial evidence changed practice patterns? BMJ Open 2019; 9:e031118. [PMID: 31488493 PMCID: PMC6731861 DOI: 10.1136/bmjopen-2019-031118] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVES To determine if level 1 evidence from a landmark trial changed practice patterns for treatment of patients with displaced midshaft clavicle fractures. DESIGN Retrospective cohort study. SETTING Two level 1 trauma centres. PARTICIPANTS Displaced midshaft clavicle fractures. RESULTS 686 patients met inclusion criteria. The pretrial cohort (n=108) was 68.5% male, with a mean age of 37.7 (±13.9) years. The post-trial cohort (n=578) was 76.1% male, with a mean age of 41.9 (±12.7) years. There was nearly a 10-fold increase in the patients treated with openreduction and internal fixation (ORIF) in the post-trial cohort (34.1%) compared with the pretrial cohort (3.7%) (p<0.001). Patients in the post-trial cohort were more likely to undergo ORIF if they were <40 years (OR=2.2; 95% CI 1.53 to 3.10), if their Injury Severity Score was >9 (OR=1.6; 95% CI 0.89 to 2.99) or if they were treated at a centre that participated in the Canadian Orthopaedic Trauma Society (COTS) trial (OR=5.2; 95% CI 3.31 to 8.21). CONCLUSIONS This study demonstrated a significant shift towards more frequent ORIF for displaced midshaft clavicle fractures following the COTS trial. Quantifying changes in practice pattern following publication of level 1 evidence is important to further our understanding of the impact large randomisedclinical trails are having on clinical practice.
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Affiliation(s)
- Prism Schneider
- Foothills Medical Centre, University of Calgary, Calgary, Alberta, Canada
| | | | - Edward Harvey
- Orthopaedics, Montreal General Hospital, Montreal, Quebec, Canada
| | - Julie Agel
- Orthopaedics, Harborview Medical Center, Seattle, Washington, USA
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Butler BA, Butler CM, Peabody TD. Cognitive Apprenticeship in Orthopaedic Surgery: Updating a Classic Educational Model. JOURNAL OF SURGICAL EDUCATION 2019; 76:931-935. [PMID: 30738729 DOI: 10.1016/j.jsurg.2019.01.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/22/2018] [Revised: 08/24/2018] [Accepted: 01/15/2019] [Indexed: 06/09/2023]
Abstract
OBJECTIVE To define cognitive apprenticeship and describe how it can be applied to orthopedic education. DESIGN Traditional apprenticeships have been used through history as a teaching model for wide variety of skills. These apprenticeships are characterized by practical, on-the-job training in which the apprentice observes and assists a master in the completion of a task, and thereby learns the skills needed to complete that task on his or her own. RESULTS Cognitive apprenticeship is differentiated from the traditional apprenticeship model primarily by its educational goals. Cognitive apprenticeships are used to teach skills which require internal though processes which cannot be readily observed externally by the teacher or the student. CONCLUSION Here, we review the history of the cognitive apprenticeship concept, its basic principles, its applications to a wide variety of educational circumstances, and its potential use a framework for developing orthopedic curricula.
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Affiliation(s)
- Bennet A Butler
- Department of Orthopaedic Surgery, Northwestern Memorial Hospital, Chicago, Illinois.
| | - Cameron M Butler
- University of Maryland College of Education, College Park, Maryland
| | - Terrance D Peabody
- Department of Orthopaedic Surgery, Northwestern Memorial Hospital, Chicago, Illinois
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Ryu R, Campbell A, Jain N, Stammen K, Yu E. Development of a Spine Surgical Skills and Written Assessment for Orthopaedic Surgery Residents. JOURNAL OF SURGICAL EDUCATION 2019; 76:1094-1100. [PMID: 30962071 DOI: 10.1016/j.jsurg.2019.01.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/04/2018] [Revised: 08/28/2018] [Accepted: 01/15/2019] [Indexed: 06/09/2023]
Abstract
OBJECTIVE The objective of this study was to develop an assessment module for orthopaedic spine surgery residents which is cost-effective and can reliably test knowledge and surgical skills. DESIGN A ten-question multiple choice question and hands-on spine sawbones combination assessment was prospectively administered to consenting PGY-3 and PGY-4 residents before and after their 8-week spine rotation. Pre- and postrotation scores were compared using the paired t-test. SETTING The Department of Orthopaedics, The Ohio State University Wexner Medical Center, a large academic medical centre providing primary and tertiary care. PARTICIPANTS Orthopaedic resident physicians. RESULTS A total of 21 residents (15 PGY-3, 6 PGY-4) participated in the study. The mean pre- and postrotation written test score was 7.38 ± 1.53 and 9.24 ± 0.83, respectively (p < 0.001). Corresponding surgical skills assessment scores were 95.4% ± 4.7 and 97.1% ± 2.6, respectively (p = 0.10). Overall, the postrotation written and surgical scores improved and showed less variation about the mean. CONCLUSIONS This combination assessment measured improvement in below-average scoring residents and maintenance or improvement in residents with average and above average prerotation scores.
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Affiliation(s)
- Robert Ryu
- The Ohio State University Wexner Medical Center, Department of Orthopaedics, Columbus, Ohio
| | - Andrew Campbell
- The Ohio State University Wexner Medical Center, Department of Orthopaedics, Columbus, Ohio
| | - Nikhil Jain
- The Ohio State University Wexner Medical Center, Department of Orthopaedics, Columbus, Ohio
| | - Kari Stammen
- The Ohio State University Wexner Medical Center, Department of Orthopaedics, Columbus, Ohio
| | - Elizabeth Yu
- The Ohio State University Wexner Medical Center, Department of Orthopaedics, Columbus, Ohio.
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Achten J, Sones W, Dias J, Hedley H, Cook JA, Dritsaki M, Png ME, Gray A, Lamb SE, Costa ML. Surgical fixation with K-wires versus plaster casting in the treatment of dorsally displaced distal radius fractures: protocol for Distal Radius Acute Fracture Fixation Trial 2 (DRAFFT 2). BMJ Open 2019; 9:e028474. [PMID: 30904879 PMCID: PMC6475232 DOI: 10.1136/bmjopen-2018-028474] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
INTRODUCTION Optimal management of distal radius fractures in adults remains controversial. Previous evidence and current clinical guidelines tell us that, if a closed reduction of a dorsally displaced fracture is possible, Kirschner wires (K-wires) are the preferred form of surgical fixation. However, the question remains whether there is any need to perform surgical fixation following a successful closed reduction, or is a simple plaster cast as effective? This is the protocol for a randomised controlled trial of manipulation and surgical fixation with K-wires versus manipulation and casting in the treatment of dorsally displaced distal radius fractures. METHODS AND ANALYSIS Adult patients with an acute dorsally displaced fracture of the distal radius are potentially eligible to take part. Prior to surgery, baseline demographic data, radiographs, data on pain/function using the Patient-Rated Wrist Evaluation Score (PRWE) and health-related quality of life (HRQoL) using the EuroQoL 5-dimension 5-level (EQ-5D-5L) will be collected. A randomisation sequence, stratified by centre, intra-articular extension of the fracture and age, will be administered via a secure web-based service. Each patient will be randomly allocated to either 'manipulation and surgical fixation with K-wires' or 'manipulation and plaster casting'. A clinical assessment, radiographs and records of early complications will be recorded at 6 weeks. PRWE and HRQoL outcome data will be collected at 3, 6 and 12 months post-randomisation. Further information will be requested with regard to healthcare resource use and any complications. ETHICS AND DISSEMINATION The National Research Ethic Committee approved this study on 6 October 2016 (16/SC/0462).The National Institute for Health Research Health Technology Assessment monograph and a manuscript to a peer-reviewed journal will be submitted on completion of the trial. The results of this trial will substantially inform clinical practice on the clinical and cost-effectiveness of the treatment of this injury. TRIAL REGISTRATION NUMBER ISRCTN11980540; Pre-results.
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Affiliation(s)
- Juul Achten
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - William Sones
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Joseph Dias
- Department of Orthopedics, Leicester General Hospital, Leicester, UK
| | - Helen Hedley
- Department of Orthopaedics, University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK
| | - Jonathan A Cook
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Melina Dritsaki
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - May Ee Png
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Alastair Gray
- Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Sarah E Lamb
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Matthew L Costa
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
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Kazan R, Viezel-Mathieu A, Cyr S, Hemmerling TM, Gilardino MS. The Montreal Augmentation Mammaplasty Operation (MAMO) Simulator: An Alternative Method to Train and Assess Competence in Breast Augmentation Procedures. Aesthet Surg J 2018; 38:835-849. [PMID: 29506205 DOI: 10.1093/asj/sjx267] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Surgical residents' exposure to aesthetic procedures remains limited in residency training. The development of the Montreal augmentation mammaplasty operation (MAMO) simulator aims to provide an adjunctive training method and assessment tool to complement the evolving competency-based surgical curriculum. OBJECTIVES To perform face, content, and construct validations of the MAMO simulator for subpectoral breast augmentation procedures and assess the reliability of the assessment scales used. METHODS Plastic surgery staff and residents were recruited to perform a subpectoral breast augmentation on the simulator. Video recordings of their performance were blindly evaluated using the objective structured assessment of technical skills (OSATS) system consisting of the global rating scale (GRS), mammaplasty objective assessment tool (MOAT), and a surgery-specific Checklist score. RESULTS Fourteen plastic surgery residents and seven expert plastic surgeons were enrolled. Experts' performance was significantly higher than residents' according to each of GRS, MOAT, and Checklist scores. Mean values of residents and experts were 23.4 (2.5) vs 36.9 (3.1) (P < 0.0001) for GRS score, 30.4 (2.2) vs 40 (3.2) (P < 0.0001) for MOAT scores, and 9.7 (1.5) vs 12 (1) (P < 0.001) for Checklist scores, respectively. Face and content validations showed excellent results among parameters evaluated, with an overall mean score of 4.8 (0.3) on 5. Cronbach's alpha was 0.96 and 0.83 for GRS and MOAT scores, respectively. Intraclass correlation coefficients for interrater reliability were excellent at 0.93, 0.92, and 0.89 for the GRS, MOAT, and Checklist scores, respectively. CONCLUSIONS This study proves the construct simulator to be valid and the assessment scales to be reliable.
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Affiliation(s)
- Roy Kazan
- Division of Plastic and Reconstructive Surgery, Department of Surgery, McGill University, Montreal, Quebec, Canada
| | - Alex Viezel-Mathieu
- Division of Plastic and Reconstructive Surgery, Department of Surgery, McGill University, Montreal, Quebec, Canada
| | - Shantale Cyr
- Intelligence Technologies of Anesthesia Group Laboratory, Department of Anesthesia, McGill University
| | | | - Mirko S Gilardino
- Division of Plastic and Reconstructive Surgery, Department of Surgery, McGill University, Montreal, Quebec, Canada
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Agyeman KD, Dodds SD, Klein JS, Baraga MG, Hernandez VH, Conway S. Innovation in Resident Education: What Orthopaedic Surgeons Can Learn from Other Disciplines. J Bone Joint Surg Am 2018; 100:e90. [PMID: 29975267 DOI: 10.2106/jbjs.17.00839] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Affiliation(s)
- Kofi D Agyeman
- Department of Orthopaedic Surgery and Rehabilitation, University of Miami/Jackson Memorial Hospital, Miami, Florida
| | - Seth D Dodds
- Department of Orthopaedic Surgery and Rehabilitation, University of Miami/Jackson Memorial Hospital, Miami, Florida
| | - Jason S Klein
- Department of Orthopaedic Surgery and Rehabilitation, University of Miami/Jackson Memorial Hospital, Miami, Florida
| | - Michael G Baraga
- Department of Orthopaedic Surgery and Rehabilitation, University of Miami/Jackson Memorial Hospital, Miami, Florida
| | - Victor H Hernandez
- Department of Orthopaedic Surgery and Rehabilitation, University of Miami/Jackson Memorial Hospital, Miami, Florida
| | - Sheila Conway
- Department of Orthopaedic Surgery and Rehabilitation, University of Miami/Jackson Memorial Hospital, Miami, Florida
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Taylor LK, Thomas GW, Karam MD, Kreiter CD, Anderson DD. Developing an objective assessment of surgical performance from operating room video and surgical imagery. ACTA ACUST UNITED AC 2018; 88:110-116. [PMID: 29963653 DOI: 10.1080/24725579.2017.1418767] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
An unbiased, repeatable process for assessing operating room performance is an important step toward quantifying the relationship between surgical training and performance. Hip fracture surgeries offer a promising first target in orthopedic trauma because they are common and they offer quantitative performance metrics that can be assessed from video recordings and intraoperative fluoroscopic images. Hip fracture repair surgeries were recorded using a head-mounted point-of-view camera. Intraoperative fluoroscopic images were also saved. The following performance metrics were analyzed: duration of wire navigation, number of fluoroscopic images collected, degree of intervention by the surgeon's supervisor, and the tip-apex distance (TAD). Two orthopedic traumatologists graded surgical performance in each video independently using an Objective Structured Assessment of Technical Skill (OSATS). Wire navigation duration correlated with weeks into residency and prior cases logged. TAD correlated with cases logged. There was no significant correlation between the OSATS total score and experience metrics. Total OSATS score correlated with duration and number of fluoroscopic images. Our results indicate that two metrics of hip fracture wire navigation performance, duration and TAD, significantly differentiate surgical experience. The methods presented have the potential to provide truly objective assessment of resident technical performance in the OR.
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Affiliation(s)
- Leah K Taylor
- Department of Orthopedics and Rehabilitation, Department of Biomedical Engineering, University of Iowa, Iowa City, IA, USA
| | - Geb W Thomas
- Department of Mechanical and Industrial Engineering, Department of Orthopedics and Rehabilitation, University of Iowa, Iowa City, IA, USA
| | - Matthew D Karam
- Department of Orthopedics and Rehabilitation, University of Iowa Hospitals and Clinics, Iowa City, IA, USA
| | | | - Donald D Anderson
- Department of Orthopedics and Rehabilitation, Department of Biomedical Engineering, Department of Mechanical and Industrial Engineering, University of Iowa, Iowa City, IA, USA
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Butler BA, Lawton CD, Burgess J, Balderama ES, Barsness KA, Sarwark JF. Simulation-Based Educational Module Improves Intern and Medical Student Performance of Closed Reduction and Percutaneous Pinning of Pediatric Supracondylar Humeral Fractures. J Bone Joint Surg Am 2017; 99:e128. [PMID: 29206799 DOI: 10.2106/jbjs.17.00425] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Simulation-based education has been integrated into many orthopaedic residency programs to augment traditional teaching models. Here we describe the development and implementation of a combined didactic and simulation-based course for teaching medical students and interns how to properly perform a closed reduction and percutaneous pinning of a pediatric supracondylar humeral fracture. METHODS Subjects included in the study were either orthopaedic surgery interns or subinterns at our institution. Subjects all completed a combined didactic and simulation-based course on pediatric supracondylar humeral fractures. The first part of this course was an electronic (e)-learning module that the subjects could complete at home in approximately 40 minutes. The second part of the course was a 20-minute simulation-based skills learning session completed in the simulation center. Subject knowledge of closed reduction and percutaneous pinning of supracondylar humeral fractures was tested using a 30-question, multiple-choice, written test. Surgical skills were tested in the operating room or in a simulated operating room. Subject pre-intervention and post-intervention scores were compared to determine if and how much they had improved. RESULTS A total of 21 subjects were tested. These subjects significantly improved their scores on both the written, multiple-choice test and skills test after completing the combined didactic and simulation module. Prior to the module, intern and subintern multiple-choice test scores were significantly worse than postgraduate year (PGY)-2 to PGY-5 resident scores (p < 0.01); after completion of the module, there was no significant difference in the multiple-choice test scores. After completing the module, there was no significant difference in skills test scores between interns and PGY-2 to PGY-5 residents. Both tests were validated using the scores obtained from PGY-2 to PGY-5 residents. CONCLUSIONS Our combined didactic and simulation course significantly improved intern and subintern understanding of supracondylar humeral fractures and their ability to perform a closed reduction and percutaneous pinning of these fractures.
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Affiliation(s)
- Bennet A Butler
- Department of Orthopedic Surgery, Northwestern Memorial Hospital, Chicago, Illinois
| | - Cort D Lawton
- Department of Orthopedic Surgery, Northwestern Memorial Hospital, Chicago, Illinois
| | - Jamie Burgess
- Division of Orthopedic Surgery, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois
| | - Earvin S Balderama
- Department of Mathematics and Statistics, Loyola University Chicago, Chicago, Illinois
| | - Katherine A Barsness
- Departments of Surgery and Medical Education, Northwestern University Feinberg School of Medicine, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois
| | - John F Sarwark
- Division of Orthopedic Surgery, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois
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Seeley MA, Fabricant PD, Lawrence JTR. Teaching the Basics: Development and Validation of a Distal Radius Reduction and Casting Model. Clin Orthop Relat Res 2017; 475:2298-2305. [PMID: 28374350 PMCID: PMC5539021 DOI: 10.1007/s11999-017-5336-3] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2016] [Accepted: 03/24/2017] [Indexed: 01/31/2023]
Abstract
BACKGROUND Approximately one-third of reduced pediatric distal radius fractures redisplace, resulting in further treatment. Two major modifiable risk factors for loss of reduction are reduction adequacy and cast quality. Closed reduction and immobilization of distal radius fractures is an Accreditation Council for Graduate Medical Education residency milestone. Teaching and assessing competency could be improved with a life-like simulation training tool. QUESTIONS/PURPOSES Our goal was to develop and validate a realistic distal radius fracture reduction and casting simulator as determined by (1) a questionnaire regarding the "realism" of the model and (2) the quantitative assessments of reduction time, residual angulation, and displacement. METHODS A distal radius fracture model was created with radiopaque bony segments and articulating elbows and shoulders. Simulated periosteum and internal deforming forces required proper reduction and casting techniques to achieve and maintain reduction. The forces required were estimated through an iterative process through feedback from experienced clinicians. Embedded monofilaments allowed for quantitative assessment of residual displacement and angulation through the use of fluoroscopy. Subjects were asked to perform closed reduction and apply a long arm fiberglass cast. Primary performance variables assessed included reduction time, residual angulation, and displacement. Secondary performance variables consisted of number of fluoroscopic images, casting time, and cast index (defined as the ratio of the internal width of the forearm cast in the sagittal plane to the internal width in the coronal plane at the fracture site). Subject grading was performed by two blinded reviewers. Interrater reliability was nearly perfect across all measurements (intraclass correlation coefficient range, 0.94-0.99), thus disagreements in measurements were handled by averaging the assessed values. After completion the participants answered a Likert-based questionnaire regarding the realism of simulation. Eighteen participants consented to participate in the study (eight attending pediatric orthopaedic surgeons, six junior residents, four senior residents). The performances of junior residents (Postgraduate Year [PGY] 1-2), senior residents (PGY 3-5), and attending surgeons were compared using one-way ANOVA with Tukey's-adjusted pairwise comparisons. RESULTS The majority of participants (15 of 18) felt that the model looked, felt, and moved like a human forearm. All participants strongly agreed that the model taught the basic steps of fracture reduction and should be implemented in orthopaedic training. Attending surgeons reduced fractures in less time than junior residents (60 ± 27 seconds versus 460 ± 62 seconds; mean difference, 400 seconds; 95% CI, 335-465 seconds; p < 0.001). Residual angulation was greater for junior residents when compared with attending surgeons on AP (7° ± 5° versus 0.7° ± 0.9°; mean difference, 6.3°; 95% CI, 3°-11°; p = 0.003) and lateral (27° ± 7° versus 7° ± 5°; mean difference, 20°; 95% CI, 13°-27°; p = 0.001) radiographs. Similarly, residual displacement was greater for junior residents than either senior residents (mean difference, 16 mm; 95% CI, 2-34 mm; p = 0.05) or attending surgeons (mean difference, 15 mm; 95% CI, 3-27 mm; p = 0.02) on lateral images. There were no differences identified in secondary performance variables (number of fluoroscopic images, casting time, and cast index) between groups. CONCLUSIONS This is the first distal radius fracture reduction model to incorporate an elbow and shoulder and allow quantitative assessment of the fracture reduction. This simulator may be useful in an orthopaedic resident training program to help them reach a defined minimum level of competency. This simulator also could easily be integrated in other accreditation and training programs, including emergency medicine. LEVEL OF EVIDENCE Level II, therapeutic study.
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Affiliation(s)
- Mark A Seeley
- Geisinger Medical Center, 100 N Academy Avenue, Danville, PA, 17821, USA.
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Morgan M, Aydin A, Salih A, Robati S, Ahmed K. Current Status of Simulation-based Training Tools in Orthopedic Surgery: A Systematic Review. JOURNAL OF SURGICAL EDUCATION 2017; 74:698-716. [PMID: 28188003 DOI: 10.1016/j.jsurg.2017.01.005] [Citation(s) in RCA: 54] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/12/2016] [Revised: 10/15/2016] [Accepted: 01/04/2017] [Indexed: 06/06/2023]
Abstract
OBJECTIVE To conduct a systematic review of orthopedic training and assessment simulators with reference to their level of evidence (LoE) and level of recommendation. DESIGN Medline and EMBASE library databases were searched for English language articles published between 1980 and 2016, describing orthopedic simulators or validation studies of these models. All studies were assessed for LoE, and each model was subsequently awarded a level of recommendation using a modified Oxford Centre for Evidence-Based Medicine classification, adapted for education. RESULTS A total of 76 articles describing orthopedic simulators met the inclusion criteria, 47 of which described at least 1 validation study. The most commonly identified models (n = 34) and validation studies (n = 26) were for knee arthroscopy. Construct validation was the most frequent validation study attempted by authors. In all, 62% (47 of 76) of the simulator studies described arthroscopy simulators, which also contained validation studies with the highest LoE. CONCLUSIONS Orthopedic simulators are increasingly being subjected to validation studies, although the LoE of such studies generally remain low. There remains a lack of focus on nontechnical skills and on cost analyses of orthopedic simulators.
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Affiliation(s)
- Michael Morgan
- School of Medicine, King's College London, London, United Kingdom
| | - Abdullatif Aydin
- MRC Centre for Transplantation, Guy's Hospital, King's College London, London, United Kingdom.
| | - Alan Salih
- Department of Orthopedic Surgery, East Sussex Healthcare NHS Trust, Eastbourne, United Kingdom
| | - Shibby Robati
- Department of Orthopedic Surgery, East Sussex Healthcare NHS Trust, Eastbourne, United Kingdom
| | - Kamran Ahmed
- MRC Centre for Transplantation, Guy's Hospital, King's College London, London, United Kingdom
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