Simulation is increasingly perceived as an important component of surgical training. Cadaveric simulation offers an experience that can closely simulate operating on a living patient. We have explored the feasibility of providing cadaveric training for the whole curriculum for trauma and orthopaedic surgery speciality trainees, before they perform those operations on living patients. An eight station surgical training centre was designed and built adjacent to the mortuary of a University Hospital. Seven two-day courses for foot and ankle, knee, hip, spine, shoulder and elbow, hand and wrist, and trauma surgery were designed and delivered. These courses, designed for 16 trainees, were delivered by eight consultant trainers and a course director. Each was structured to allow every trainee to perform each standard operation in the curriculum for that respective subspecialty. We designed the courses to maximise simulated operating time for the trainees and to minimise cost. We surveyed trainers and trainees after the courses to qualitatively assess their value.Introduction
Methods
This study assesses the pre and post-operative pedal pressures during stance phase of dynamic gait cycle to identify objective biomechanical factors which influence the final outcome.
Pedobarography was performed before and 8 months after surgery, on an average. Sole was divided into eight segments i.e. heel, midfoot, lateral forefoot, central forefoot, medial forefoot, II–V toes, hallux and total sole area. Variables compared were contact area, peak pressure, mean pressure and contact time. Manchester-Oxford foot questionnaire (MOXFQ) was used to assess the clinical disability. The inter-metatarsal and metatarso-phalengeal angles were measured radiographically. Both clinical and radiological assessments were performed pre and post-operatively.
The inter-metatarsal angle reduced from 15 to 7 (p 0.001) and the metatarso-phalengeal angle reduced from 32 to 9 (p 0.001). There was significant reduction in heel contact area (p 0.002), the medial forefoot (p 0.030) and II – V toes (p 0.048) contact time.