Surgical Residents´ Results Seem to be Non-Inferior Comparing to More Experienced Surgeons in Femoral Neck Fracture Osteosynthesis

Purpose of the Study

Femoral neck fracture osteosynthesis is usually performed by using dynamic hip screw (DHS) or multiple parallel cannulated screws (MCS). In orthopedic surgery training, certain hip fractures are one of the most common operations performed by residents. It has been questioned, whether residents can provide as safe treatment and patient outcomes as those of more experienced surgeons. The aim of this study was to evaluate the effect of surgical experience on risk of complications by comparing the surgical performance and clinical outcomes in femoral neck osteosyntheses between surgical residents and orthopaedic surgeons.

Methods

All patients with femoral neck fracture admitted to Helsinki and Uusimaa Hospital District (HUS) Hyvinkää Hospital from 2011 to 2016 were collected as research material. 88 hip fractures (87 patients) treated with DHS or MCS osteosyntheses were included in this study. The patients were divided into 2 groups, based on the surgeon's experience: an orthopedic surgeon group (n = 68) and a surgical resident group (n = 20). All data from complications, reoperations, and the duration of operations were collected.

Results

There was no significant difference in characteristics of operated patients between orthopaedics and residents group. There was no significant difference in complications or re-operations between groups (p = 0.4, p = 0.2). Surgical residents had statistically longer surgical time (mean 76 min, 95% CI 62.92 min, mean 46 min, 95% Cl 42.51 min; p-value < 0.001). Still surgical time was not a risk factor for complication (p-value 0.5).

Conclusion

Our results show that surgical residents´ outcomes in femoral neck fracture osteosynthesis seem to be as favorable as those of orthopedic surgeons; the operations just last slightly longer.

Anterior cruciate ligament reconstruction learning curve study - Comparison of the first 50 consecutive patients of five orthopaedic surgeons during a 5-year follow-up

BACKGROUND

The goal of all surgical and orthopaedic training is to ensure necessary education and surgical skills without compromising the quality of operations or patient safety. Anterior cruciate ligament reconstruction (ACLR) is a common multi-staged orthopaedic surgical procedure with a learning curve. Previous studies focus mainly on learning or the learning curve of one surgeon and tunnel placements. The aims of this study were to define the learning curve in arthroscopic ACLRs, define the number of procedures needed before the surgical "knifetime" plateaus, examine the effect of experience on complications, and identify possible individual differences in the surgical learning curve.

METHODS

The study included the first 50 consecutive ACLR operations of five orthopaedic surgeons, thus, a total of 250 patients. For comparison and statistical analysis, patients were arranged into five groups, each comprising 50 patients (=order group). Order group 1 comprised the first 10 patients operated on by each of the five surgeons, group 2 patients 11-20, group 3 patients 21-30, group 4 patients 31-40, and group 5 the last 10 patients. The learning curve was defined with a LOESS curve. Surgical time and complications, including graft failure and postoperative knee instability, were analysed between order groups and between surgeons.

RESULTS

Median surgical time was 105 (interquartile range 82-124) min. The learning curve showed the first steep decline in surgical time and started to settle slowly after 20 reconstructions. Surgical time was significantly longer when order group 1 was compared with order group 2 (p = 0.031), and when order group 1 was compared separately with order groups 3, 4, and 5 (p < 0.001). Operation order alone explained only 17.1% of the alteration in surgical time. No significant difference emerged in graft failure rate between the order groups or the surgeons. Objective instability of the knee showed a significant difference when order group 1 was compared separately with order group 3 and with order group 4 (p = 0.004). Surgical time differed between surgeons (p < 0.001), and the shape of the learning curve showed great individual variability.

CONCLUSION

In the first 10 to 20 ACLR operations, the surgical time was longer and the complication rate higher, but thereafter both started to settle down. We recommend that first 10-20 ACLR operations should be supervised.

Blood volume assessment with hemoglobin subtype analysis in preterm infants

The aim of the study was to assess plasma volume (PV) and red cell volume (RCV) in preterm infants with a liquid chromatographic hemoglobin subtype method (HbST) based on dilution of autologous fetal hemoglobin (HbF) by donor adult hemoglobin and measurement of the amount of HbF. PV determination with the indocyanine green dye dilution technique (ICG) was used as a reference method. Eight infants, median gestational age 29.8 weeks (range 27.6-30.9 weeks) and median birth weight 1,300 g (range 1,030-1,760 g), were studied at a median age of 3.0 days (range 1-6 days). RCV was 33.6 +/- 12 ml/kg measured with ICG and 32.1 +/- 5.2 ml/kg with HbST. PV was 47.0 +/- 18 and 40.2 +/- 6.6 ml/kg, respectively. There was a close correlation between the RCVs measured with the two techniques (Pearson correlation 0.83, p < 0.05). In conclusion, HbST provides a reliable and safe determination of RCV in preterm infants.

Time-resolved fluoroimmunoassay for plasma enterolactone

We present a method for the determination of the lignan enterolactone in plasma (serum). This compound, produced by intestinal bacteria from matairesinol and secoisolariciresinol in fiber-rich food, is a biomarker related to the intake of a healthy diet. The method is based on time-resolved fluoroimmunoassay using a europium chelate as a label. After synthesis of 5'-O-carboxymethoxyenterolactone the compound is coupled to bovine serum albumin and then used as antigen in immunization of rabbits. The tracer with the europium chelate is synthesized using the same 5'-derivative of enterolactone. After enzymatic hydrolysis and ether extraction the immunoassay is carried out using the VICTOR 1420 multilabel counter (Wallac Oy, Turku, Finland). No antiserum cross-reactivity with available lignans, isoflavonoids, or flavonoids could be detected. The intraassay and interassay coefficients of variation at different concentrations vary 4.6-6.0 and 5.5-9.9, respectively. The working range of the assay is 1.5-540 nmol/liter. We measured enterolactone in serum/plasma of 224 Finnish subjects: 98.8% of the subjects had values <100 nmol/liter, 38.0% had 20-39.9 nmol/liter, and 34.4% had <20 nmol/liter.