Surgical training is based on an apprenticeship model. This training can be divided broadly into three main categories: practical skills, knowledge and decision making. The operating room is the nexus of a large part of surgical teaching. The supervising surgeon imparts both practical teaching as well as didactic information to the trainee during surgical procedures. A large amount of decision making skills are also acquired in the OR. Indeed, a large part of the surgical teams time is spent in the operating room which makes it an ideal educational environment. Bench model training is one teaching modality whereby the novice surgeon is taught surgical skills on life-like models. This practice enhances and accelerates the ability of the trainee to acquire fundamental, technical and surgical skills in the operating room. Whether bench model training provides an advantage on the ability of the trainee to acquire knowledge and decision making skills is unknown. Based on the motor learning theories, it is hypothesized that bench-model training will allow junior residents to be more interactive than trainees lacking similar active hands-on training. In this study, we examined whether bench model training provides an advantage on the ability of the trainee to acquire knowledge and decision making skills. 30 junior surgical residents from various surgical divisions, with minimal knowledge of technical, procedural and cognitive skills related to the ulna bone fixation (primary task), were recruited in this study. 15 residents, randomly assigned, were given instructions and the benefit of practice on a bench model, and 15 were given instructions but not the chance to practice the skill on a bench model. All residents, while tested for their accuracy and time taken for ulna fixation (secondary task, decision making skills), were also verbally taught information on different aspects of primary bone healing. This information was evaluated by a multiple-choice test (knowledge acquisition).Purpose
Method
Intra-medullarly nail techniques for fracture fixation has gained Universal acceptance over the past 50 years. Closed interlocking nail fixation is the procedure of choice for femoral shaft fracture specially in poly trauma. Unlocked Nail can be considered when a non comminuted fracture occurs through the narrowest part of the medullarly canal. Unlocked Nail does not resist axial and rotational deformation of the fracture. Interlocking fixation controls bending and rotational deformation but allows nearly full axial load transfer by bone. Interlocking nails can be used in almost all long bones. A total of 67 cases were stabilized by intra-medullarly interlocking nails. It was a prospective study done in SSMC &
Private hospital from the period of January 2004 to February 2008. Total period of follow up was about 4 years. Both male &
female were included in this series. Fresh, delayed fracture &
Non Union all were included. Maximum cases were closed fracture but few were fresh but open fracture. Simple unstable fracture comminuted segmental fracture, implant failure was the selection criteria. Fracture, tibia femur and humerus were selected for this study. Both closed and open techniques were applied in this series without any support from C-arm. In maximum cases bony union was achieved in expected time. In few cases healing process was delayed due to extensive soft tissue damage during the occurrence of fracture and non-cooperation of patients during post operative period. Excellent results were achieved in fresh cases. Over all result of this series is very satisfactory. Breaking of screws was in 2 cases, bending of nail was in one case due to early weight bearing. Revision of surgery done in 2 cases. Intra Modularly interlocking nail fixation is very simple device for unstable comminuted and segmental fracture shaft of long bones. If C-arm is available in that case procedure becomes more simple and easy. But without C-arm sometimes surgery becomes very lengthy and in that case expected results may not be achieved.
