Abstract

This project was funded by “start-up” funds by the Department of Surgery, Division of Orthopaedics, University of Toronto

Purpose

Case logs have been utilized as a means of assessing residents surgical exposure and involvement in cases. It can be argued that the degree of involvement in operative cases is as important as absolute number of cases logged. A log which contains accurate information on actual participation in surgical cases in addition to self reported competency, is a powerful tool in obtaining a true reflection of surgical experience. Thus a prerequisite for a valuable log is the ability to perform an accurate self-assessment. Numerous studies have shown mixed results when examining residents ability to perform self-assessment on varying tasks. The purpose of the study was to examine the correlation between residents self-assessment and staff surgeons evaluation of surgical involvement and competence in performing primary hip and knee arthroplasty surgery.

Purpose: Given recent evolving guidelines regarding maximum allowable work hours and emphasis on resident quality of life, novel strategies are required for implementing call schedules. The night float system has been used by some institutions as a strategy to decrease the burden of call on resident quality of life in level one trauma centres. The purpose of this study was to determine whether there are differences in quality of life, work-related stressors, and educational experience between orthopaedic surgery residents in the night float and standard call systems at two level one trauma centres.

Method: This was a prospective cohort study at two level one trauma hospitals comprised of a standard call (1 in 4) group and a night float (5pm-7am, Sunday to Friday) group for each hospital, respectively. Residents completed the Short Form 36 (SF-36) general quality-of-life questionnaire, as well as, questionnaires on stress level and educational experience before the rotation (baseline), at two, four and subsequently at six months. An analysis of covariance (ANCOVA) approach was used to compare between-group differences using the baseline scores as covariates. Wilcoxon Signed-Rank tests (non-parametric) were used to determine if the residents’ SF-36 scores were different from the age and sex matched Canadian norms. Predictors of resident quality of life were analyzed using multivariable mixed models.

Results: Seven residents were in the standard call group and nine in the night float group for a total of 16 residents (all males, mean age=35.1 yrs). Controlling for between-group differences at baseline, residents on the night float rotation had significantly lower role physical (RP), bodily pain (BP), social function (SF) subscale scores (p< 0.05).

Conclusion: Our study suggests that the residents in the standard call group had better health related quality of life in comparison with the night float group. No differences existed in subjective educational benefits and stress level between the groups. The study findings may be limited due to the small sample size. However, this sample size is substantial given the size of most orthopaedic residency programs in North America.

Introduction: The Evan’s staple is an intramedullary device. It has two 20 cm tines connected by a horizontal bar with a hole mid-apex to facilitate insertion over a K-wire and enhance fixation to the humerus by means of a tension band.

Aim: To perform a retrospective review of the results of using the Evan’s staple as a means of fixation for displaced proximal humeral fractures.

Method: Between 1989 and 1997 at the Toronto East General Hospital, 56 patients with displaced proximal humeral fractures were treated with an Evans’ staple. This included 14 three-part and four four-part fractures and six fracture-dislocations. The age range at the time of operation was 18–94 years. The average duration of follow-up was 48.6 months, the range being 11–99 months. The study consisted of patient chart review, radiological review and use of the DASH (Disabilities of the Arm, Shoulder and Hand) questionnaire.

Results: Complete radiological data were available for 26 patients and these showed a 100% union rate. The majority (77%) healed in neutral, the remainder in varying degrees of varus. Twenty-one patients returned the DASH questionnaire, with an average functional score of 37.8 (0= no disability, 100= severe disability). The complications included eight cases of impingement that required staple removal and one fracture distal to a staple caused by a subsequent fall.

Conclusion: The Evan’s staple is a viable means of fixation for displaced proximal humeral fractures.