Purpose: This study attempted to determine if the form of feedback provided by a computer-based navigation technique improves the learning of the placement of cannulated screws across a femoral neck fracture in the surgical trainee.

Method: A prospective, randomized, appropriately powered, and controlled study involving 39 surgical trainees (first-year residents and fourth-year medical students) with no prior experience in surgically managing femoral neck fractures were used in the study. After a training session, participants underwent a pretest by performing the surgical task on a simulated hip fracture using fluoroscopic guidance. Immediately after, 20 participants were randomized into undergoing a training session using a conventional fluoroscopy-guided technique while the other participants were randomized into undergoing a training session using a computer-based navigation technique. Immediate post-tests and retention tests (4 weeks later) were performed. A transfer test was used to assess the impact of the type of training on surgical performance – after performing the retention test, each group repeated the task but used the other technique to guide them (i.e. those trained with fluors-copy used computer navigation and vice versa).

Results: Screw placement was equal and to the level of an expert surgeon with either training technique during the post-, retention, and transfer tests. Participants that were trained with computer navigation took fewer attempts to position hardware and used less fluoroscopy time than those that trained with fluoroscopy. When participants that trained with computer navigation reverted to conventional fluoroscopic technique at the transfer test, more fluoroscopy time and dosage was used. Participants that trained with fluoroscopy used less fluoroscopy time and took fewer attempts to position hardware when they subsequently used computer navigation to perform the task during the transfer test.

Conclusion: Computer navigation does not harm the learning of surgical novices in this basic orthopaedic surgical skill. Training with computer navigation minimizes radiation exposure and decreases the number of attempts to perform the task. No compromise in learning occurs if a surgical novice trains with one type of technology and transfers to using the other.

Purpose: To determine the effect of delay to surgery on functional outcome in patients with operatively-treated acetabular fractures.

Method: Two hundred and thirty-two patients with acetabular fractures were identified from a pelvic trauma database. Functional outcome data was assessed using the validated Musculoskeletal Functional Assessment (MFA) and the Short Form 36 (SF-36) surveys in 162 patients. After 1997, functional outcome scores were collected prospectively at 6 months, 1 year and 2 years (or greater) post-operatively. Functional outcome scores, quality of reduction, and risk of complications were modeled as a function of days of delay to surgery via multivariate regression analysis adjusting for age, gender, fracture type, and associated injuries.

Results: At 6 months post-operatively, functional outcome scores were significantly worse with increasing delay to surgery. A delay of between 7 and 13 days or 14 or more days decreased the SF-36 physical component (PCS) z-scores by 0.75 (95% CI: −1.41 to −0.09) and 1.5 standard deviations (95% CI: −2.43 to −0.56) respectively. Delay of 14 or more days was associated with a worsening of the lower extremity (Move) subsection of the MFA by 18.6 points (95% CI: 3.3 to 33.8). Delay to surgery was associated with a significantly higher risk of poor reduction among those with available radiographic follow-up (n=67). Delay 14 days or more was associated with a 5 times (95% CI?.04 to 23.99) greater risk of a post operative step or gap over 2 mm. Delay to surgery was associated with an increase in thrombotic complications. In those patients who were diagnosed with a pulmonary embolism(PE) the mean delay was 11.3 days versus 7.3 days for the rest of the cohort (p=0.01). For patients with a deep vein thrombosis (DVT) average delay was 14.1 days versus 7.1 days (p=0.01).

Conclusion: Delay to surgery is associated with worsening functional outcome scores after as little as 7 days of delay. After 14 days, functional outcomes deteriorate further and radiographic outcomes are negatively influenced. Increased delay also increases risk of thrombotic events. These conclusions underscore the importance of timely treatment for displaced acetabular fractures.