Aims. The aims of this study were to describe the demographic, socioeconomic, and educational factors associated with core surgical trainees (CSTs) who apply to and receive offers for higher surgical
Aims. Arthroplasty skills need to be acquired safely during
Freehand distal interlocking of intramedullary nails remains a challenging task. If not performed correctly it can be a time consuming and radiation expensive procedure. Recently, the AO Research Institute developed a new
Evidence supporting the use of virtual reality (VR)
Background.
Aims. Global literature suggests that female surgical trainees have lower rates of independent operating (operative autonomy) than their male counterparts. The objective of this study was to identify any association between gender and lead/independent operating in speciality orthopaedic trainees within the UK national
Aims. Mechanical stimulation is a key factor in the development and healing of tendon-bone insertion. Treadmill
Aims. To evaluate if, for orthopaedic trainees, additional cadaveric simulation
Musculoskeletal (MSK) disorders continue to be a major cause of pain and disability worldwide. The mission statement of the Canadian Orthopaedic Association (COA) is to “promote excellence in orthopaedic and musculoskeletal health for Canadians,” and orthopaedic surgeons serve as leaders in addressing and improving musculoskeletal health. However, patients with MSK complaints most commonly present first to a primary care physician. According to a survey of family physicians in British Columbia, 13.7-27.8% of patients present with a chief complaint that is MSK-related (Pinney et Regan, 2001). Therefore, providing excellent MSK care to Canadians requires that all physicians, especially those involved in primary care, be adequately trained to diagnose and treat common MSK conditions. To date, there has been no assessment of the total mandatory MSK
The imminent introduction of the new Trauma & Orthopaedic (T&O) curriculum, and the implementation of the Improving Surgical
Previous Anterior Cruciate Ligament (ACL) reconstruction is currently a bar from entry to the Royal Marines and Royal Navy, whilst the British Army allows recruits to join if asymptomatic 18 months post ACL reconstruction. However current Royal Marines policy is to rehabilitate recruits who sustain an ACL disruption in
Aims. The decrease in the number of satellite cells (SCs), contributing to myofibre formation and reconstitution, and their proliferative capacity, leads to muscle loss, a condition known as sarcopenia. Resistance
Background. Musculoskeletal disorders, including low back pain, affects 68% of UK physiotherapists across their career with patient handling considered a key risk factor. Manual handling
Orthopaedic surgery is a practical surgical specialization field, the exit exam for registrars remains written and oral. Despite logbook evaluation and surgical work-based assessments, the question remains: can registrars perform elective surgery upon qualification? In South Africa, obstacles to elective surgical
Freehand distal interlocking of intramedullary nails is technical demanding and prone to handling issues. It requires the surgeon to precisely place a screw through the nail under x-ray. If not performed accurately it can be a time consuming and radiation expensive procedure. The aims of this study were to assess construct and face validity of a new
Aims. Evidence exists of a consistent decline in the value and time that medical schools place upon their undergraduate orthopaedic placements. This limited exposure to trauma and orthopaedics (T&O) during medical school will be the only experience in the speciality for the majority of doctors. This review aims to provide an overview of undergraduate orthopaedic
Simulation use in
Abstract. Introduction. Challenges in surgical
The COVID-19 pandemic has disrupted all segments of daily life, with the healthcare sector being at the forefront of this upheaval. Unprecedented efforts have been taken worldwide to curb this ongoing global catastrophe that has already resulted in many fatalities. One of the areas that has received little attention amid this turmoil is the disruption to trainee education, particularly in specialties that involve acquisition of procedural skills. Hand surgery in Singapore is a standalone combined programme that relies heavily on dedicated cross-hospital rotations, an extensive didactic curriculum and supervised hands-on
Abstract. Source of Study: London, United Kingdom. This intervention study was conducted to assess two developing protocols for quadriceps and hamstring rehabilitation: Blood Flow Restriction (BFR) and Neuromuscular Electrical Stimulation
Superior teamwork in the operating theatre is associated with improved technical performance and clinical outcomes. Yet modern rota patterns, workforce shortages, and increasing complexity of surgery, means that there is less familiarity between staff and the required choreography. Immersive Virtual Reality (iVR) can successfully train surgical staff individually, however iVR team
Superior team performance in surgery leads to fewer technical errors, reduced mortality, and improved patient outcomes. Scrub nurses are a pivotal part of this team, however they have very little structured
The Ontario Crippled Children's Centre has completed a two-year research project designed to develop effective strategies for
Aims. The primary aim of the survey was to map the current provision of simulation
Aims. Total hip arthroplasties (THAs) are performed by surgeons at various stages in
We present an evaluation of basic surgical orthopaedic operative
Abstract. Introduction. Knee arthroscopy can be used for ligamentous repair, reconstruction and to reduce burden of infection. Understanding and feeling confident with knee arthroscopy is therefore a highly important skillset for the orthopaedic surgeon. However, with limited
Introduction. Knee arthroscopy can be used for ligamentous repair, reconstruction and to reduce burden of infection. Understanding and feeling confident with knee arthroscopy is therefore a highly important skillset for the orthopaedic surgeon. However, with limited
This qualitative study aims to explore and highlight the experiences of trainees in the Orthopaedic Surgical Education
Introduction and Aim. Quadriceps strength is crucial for physical function in patients with knee osteoarthritis (KOA). This study aimed to investigate the effect of combining blood flow restriction (BFR) with low-intensity
Surgical trainees are finding it increasingly more challenging to meet operative requirements and coupled with the effects of COVID-19, we face a future of insufficiently trained surgeons. As a result, virtual reality (VR) simulator
Abstract. Objectives. Non-technical skills including teamwork play a pivotal role in surgical outcomes. Virtual reality is effective at improving technical skills, however there is a paucity of evidence on team-based virtual reality (VR)
Abstract. Objectives. Evidence supporting the use of immersive virtual reality (iVR)
Orthopaedic
Brazilian jiu-jitsu (BJJ) is a grappling-based martial art which can lead to injuries both in
Aims. The aim of this study is to determine the effects of the UK lockdown during the COVID-19 pandemic on the orthopaedic admissions, operations,
Introduction and Objective. Over the past few years, a reorganization of the educational pathways has been promoted with the purpose of optimizing the acquisition of competences and their assessment, so as to reduce the risks to both health care professionals and end users. Virtual reality (VR) has been repeatedly tested, initially as a positive reinforcement for more traditional educational pathways and, more recently, as their potential substitute. The aim of this study was to demonstrate the potentiality of VR simulation
Aims. Rotator cuff muscle atrophy and fatty infiltration affect the clinical outcomes of rotator cuff tear patients. However, there is no effective treatment for fatty infiltration at this time. High-intensity interval
There is no unified national
The Postgraduate Medical Education and
In order to assess the efficacy of inspection and accreditation by the Specialist Advisory Committee for higher surgical
Background. Revision total knee arthroplasty (rTKA) is a high stakes procedure with complex equipment and multiple steps. For rTKA using the ATTUNE system revising femoral and tibial components with sleeves and stems, there are over 240 pieces of equipment that require correct assembly at the appropriate time. Due to changing teams, work rotas, and the infrequency of rTKR, scrub nurses may encounter these operations infrequently and often rely heavily on company representatives to guide them. In turn, this delays and interrupts surgical efficiency and can result in error. This study investigates the impact of a fully immersive virtual reality (VR) curriculum on
There are significant differences in the methods and styles of orthopaedic surgical
Conventional fracture courses utilise prefabricated sawbones that are not realistic or patient specific. The aim of this study is to determine the feasibility of creating 3D fracture models and utilising them in fracture courses to teach surgical technique. We selected an AO type 2R3C2 fracture that underwent open reduction internal fixation. De-identified CT scan images were converted to a stereolithography (STL) format. This was then processed using Computer Aided Design (CAD) to create a virtual 3D model. The model was 3D printed using a combination of standard thermoplastic polymer (STP) and a porous filler to create a realistic cortical and cancellous bone. A case-based sawbone workshop was organised for residents, unaccredited registrars, and orthopaedic trainees comparing the fracture model with a prefabricated T-split distal radius fracture. Pre-operative images aided discussion of fixation, and post-operative x-rays allowed comparison between the participants fixation. Participants were provided with identical reduction tools. We created a questionnaire for participants to rate their satisfaction and experience using a Likert scale. The 3D printed fracture model aided understanding and appreciation of the fracture pattern and key fragments amongst residents and unaccredited trainees. Real case-based models provided a superior learning experience and environment to aid teaching. The generic sawbone provided easier drilling and inserting of screws. Preliminary results show that the cost of 3D printing can be comparable to generic sawbones. It is feasible to create a fracture model with a real bone feel. Further research and development is required to determine the optimum material to use for a more realistic feel. The use of 3D printed fracture models is feasible and provides an alternative to generic sawbone fracture models in providing surgical
Despite being one of the most common orthopaedic
operations, it is still not known how many arthroscopies of the knee
must be performed during
Background. For total hip arthroplasty (THA), cognitive
Background. Virtual Reality (VR) uses headsets and motion-tracked controllers so surgeons can perform simulated total hip arthroplasty (THA) in a fully-immersive, interactive 3D operating theatre. The aim of this study was to investigate the effect of laboratory-based VR
Purpose of study. To evaluate implementation of the Back Skills
With the drawdown from Afghanistan focus turns towards future operations, and their demands on the DMS.
Drilling through bone is a complex action that requires precise motor skills of an orthopedic surgeon. In order to minimize plunging and soft tissue damage, the surgeon must halt drill progression precisely following penetration of the far cortex. The purpose of this study was to create a low-cost and easy-to-use drilling simulator to train orthopedic residents in reducing the drill plunging depth. This prospective observational study was performed in the division of orthopedic surgery of a single tertiary medical center. The participants included 13 residents and 7 orthopedic specialists. The simulator consisted of a synthetic femur bone model and ordinary modeling clay, and the
In June 2012 the Orthopaedic Speciality Advisory of the Joint Committee on Surgical
When compared to magnetic resonance imaging (MRI), ultrasound (US) performed by experienced users is an inexpensive tool that has good sensitivity and specificity for diagnosing rotator cuff (RC) tears. However, many practitioners are now utilizing in-office US with little to no formal
Derriford Hospital gained Major Trauma Centre (MTC) status in April 2012, this led to a significant increase in the trauma case load. Our aim was to review registrar exposure to theatre and clinic in the elective and trauma setting. This was then compared to audits performed pre-MTC status and shortly following MTC changes to see if
Total hip replacements (THRs) are performed by surgeons at various stages in their
Surgical
Background. Accurate implant orientation is associated with improved outcomes after artificial joint replacement. We investigated if a novel augmented-reality (AR) platform (with live feedback) could train novice surgeons to orientate an acetabular implant as effectively as conventional
Purpose. Surgical
This paper discussed the challenges to provide advanced surgical
Skills simulation is increasingly used as a
Skills simulation is increasingly used as a
Background. Complications such as dislocations, impingement and early wear following total hip arthroplasty (THA) increase with acetabular cup implant malorientation. These errors are more common with low-volume centres or in novice hands. Currently, this skill is most commonly taught during real surgery with an expert trainer, but simulated
Introduction. Progressive resistance
Aims: Musculo-skeletal complaints comprise a significant proportion of General Practitioner workload. The aim of this study was to assess whether the
Background. The Fracture Fixation Assessment Tool score (FFATs) was developed as an objective evaluation of post-operative fracture fixation radiographs as a means of appraisal and education. The tool has proven validity, simple to use and based upon AO principles of fracture fixation. This study has been designed to assess how FFATs changes throughout the
Introduction. The number of complex revision total hip arthroplasties (THA) is predicted to rise. The identification of acetabular bone defects prior to revision THA has important implications on technique and complexity of acetabular reconstruction. Paprosky et al. proposed a classification system including 3 main types with up to 3 subtypes focused on the integrity of the superior rim of the acetabulum and medial wall. However, the classification system is complex and its reliability has been questioned. The purpose of this study was to evaluate the effectiveness of different radiologic imaging modalities (plain radiographs, 2-D CT, 3-D CT reconstructions) in classifying acetabular defects in revision hip arthroplasty cases and their value of at different levels of orthopaedic
The European Working Time Directive is a directive from the Council of Europe to protect the health and safety of workers in the European Union. The working time directive currently ensures a 56 working hour week and by August 2009 a 48 hour maximum working week. To accommodate such a reduction in working hours, the on call rotas for institutions have had to change. Has this had an affect on trauma exposure for current specialist registrars?. Materials and Methods: Data collection was from electronic logbooks of orthopaedic specialist registrars and locum appointment trainees on the Southwest Thames rotation. From the elogbooks indexed trauma procedures were audited, this included: dynamic hip screw, hemiarthroplasty, open reduction and internal fixation ankle, intramedullary nail femur, intramedullary nail tibia, and intramedullary nail humerus. The data was divided into year groups and then the data was subdivided into on call rotas. Obtained from the data collection was the number of indexed linked operations carried out per 6 months per year group. Results: The data collection was over an 18 month period October 2006 – April 2008. The total number of trainee logbooks who had the complete data from the logbook available was 90. The number of trainees for each year = n, the total number of operations =x and mean number of operations for each year of
Aims. The aim of this study was to conduct evidence synthesis on the available published literature of the impact of the
The Royal Marines regularly deploy to Norway to conduct Cold Weather, Arctic and Mountain Warfare
The process of obtaining informed consent is an important and complex pursuit, especially within a paediatric setting. Medical governing bodies have stated that the role of the trainee surgeon must be explained to patients and their families during the consent process. Despite this, attitudes and practices of surgeons and their trainees regarding disclosure of the trainee's participation during the consent process has not been reported in the paediatric setting. Nineteen face-to-face interviews were conducted with surgical trainees and staff surgeons at a tertiary level paediatric hospital in Toronto, Canada. These were transcribed and subsequently thematically coded by three reviewers. Five main themes were identified from the interviews. 1) Surgeons do not consistently disclose the role of surgical trainees to parents. 2) Surgical trainees are purposefully vague in disclosing their role during the consent discussion without being misleading. 3) Surgeons and surgical trainees believe parents do not fully understand the specific role of surgical trainees. 4) Graduated responsibility is an important aspect of
Utilising the (ACS-NSQIP) database, we aimed to evaluate the impact of resident level of
Aim: To investigate the
Introduction and Aims: Stability
Introduction: Surgical
Parallel operating lists are a contentious subject. Many people feel that supervision,
Aims. The aim of this study was to assess the current evidence relating
to the benefits of virtual reality (VR) simulation in orthopaedic
surgical
Background. The ability to learn arthroscopic surgery is an important aspect of modern day orthopaedic surgery. Knowing that variation in innate ability exists amongst medical students, the aim of this study was to investigate the effect of
The aim of this study was to determine whether the foundation programme for junior doctors, implemented across the United Kingdom in 2005, provides adequate
We investigated whether
Introduction and Objective. Hip osteoarthritis (OA) is the leading cause for total hip arthroplasty (THA). Although, being considered as the surgery of the century up to 23% of the patients report long-term pain and deficits in physical function and muscle strength may persist after THA. Progressive resistance
Joint assessment through manual physical examination is a fundamental skill that must be acquired by orthopaedic surgeons. These joint assessments allow surgeons to identify soft tissue injuries (e.g. ligament tears) which are critical in identifying appropriate treatment options. The difficulty in communicating the feeling of different joint conditions and the limited opportunities for practice can make these skills challenging to learn, resulting in reduced treatment effectiveness and increased costs. This research seeks to improve the
Introduction: Complex extremity injury remains a challenge to those involved in both its emergent and definitive care. Anecdotal concerns exist regarding exposure of orthopaedic trainees to such cases in the light of recent changes in surgical
Computer assisted navigation (CAN) has been shown to significantly improve the overall alignment obtained after total knee arthroplasty (TKA). Human error and the use of conventional jigs may be the reasons for the inaccuracy of conventional TKA. The impact of computer assisted equipment in surgeon
Nationwide changes in the organisation of specialist medical
Summary Statement. Incorrect pedicle screw placement can lead to neurological complications. Practice outside the operating room on realistic bone models, with force feedback, could improve safety. Pedicle forces in cadaveric specimens are reported, to support development of a
To identify a core outcome set of postoperative radiographic measurements to assess technical skill in ankle fracture open reduction internal fixation (ORIF), and to validate these against Van der Vleuten’s criteria for effective assessment. An e-Delphi exercise was undertaken at a major trauma centre (n = 39) to identify relevant parameters. Feasibility was tested by two authors. Reliability and validity was tested using postoperative radiographs of ankle fracture operations performed by trainees enrolled in an educational trial (IRCTN 20431944). To determine construct validity, trainees were divided into novice (performed < ten cases at baseline) and intermediate groups (performed ≥ ten cases at baseline). To assess concurrent validity, the procedure-based assessment (PBA) was considered the gold standard. The inter-rater and intrarater reliability was tested using a randomly selected subset of 25 cases.Aims
Methods
Since 2003 Trauma and Orthopaedic trainees in the UK and Ireland have routinely submitted data recording their operative experience electronically via the eLog-book. This provides evidence of operative experience of individuals and national comparisons of trainee, trainer, hospital and
Purpose: To evaluate fellowship trainee and supervisor perceptions on the relative importance of core cognitive and procedural competencies in spine subspecialty fellowship
Introduction. Surgical simulation and ‘virtual’ surgical tools are becoming recognised as essential aids for speciality
Inserting screws into the vertebral pedicles is a challenging step in spinal fusion and scoliosis surgeries. Errors in placement can lead to neurological complications. The more experienced the surgeon, the better the accuracy of the screw placement. A physical
Introduction: The Foundation Programme was implemented across the United Kingdom in 2005 and aims to “bridge the gap between medical school and specialty/general practice
Quality assurance for
Introduction. The education of residents in the proper placement of pedicle screws is key to the safety of the surgery. The more experienced the surgeon, the more accurately the pedicle screws tend to be placed. A physical bone model, with properties and tactile feel similar to human bone, was developed with the intention of using the bone model to train residents in pedicle screw placement. The purpose of this study was to test whether the model improves the performance of orthopaedic residents when cannulating spinal pedicles, as judged by the number of breaches, and to gain feedback from the residents on their experiences. Materials and Methods. Six orthopaedic residents were recruited, with ethics approval. Prior to testing, the residents were given an instructional video describing the correct cannulation of a lumbar vertebra. The residents were each provided with 12 bones mounted in holders: 3 for initial skills assessment, 6 for free practice, and 3 for final skills assessment. In the pre- and post-practice sets, the 3 bone models had different properties: weak, normal and strong. The residents were asked to complete both pre and post-testing questionnaires. The number of breaches was counted in initial and final bone testing. The forces for each bone model were compared using an ANOVA; these were followed by post-hoc t-tests if significant (p<0.05). Results. All but one of the residents improved the number of breaches with practice, and the one that did not improve did not make the same breaches twice. The total number of breaches in the final testing (14) was lower than in the initial testing (31). The entry points chosen by the residents were all deemed appropriate as per the video instruction. The resident with the most experience had the least number of breaches; the resident with the least amount of experience had the most breaches. Discussion. The reduction of the number of breaches between the initial and final testing indicates that the residents did learn. Overall the response from the residents was positive; they all indicated they would like to have the simulator as part of their
Introduction. There have been concerns regarding the quality of
Introduction: Despite worldwide vaccination programmes Polio is still endemic in some developing countries. Numerous new cases of polio are seen every year in India resulting in significant childhood deformity. The Rotary Club funds voluntary camps aimed at correcting deformities in children. I was part of the surgical team in Jan 2007 led by Mr. J. Clegg. Clinical experience: Some 141 procedures were carried out in 3 days, 99 by SPR’s under senior supervision. The most frequent procedure was a supra-condylar femoral osteotomy, followed by hip and knee soft tissue releases. For more complex operations we assisted or observed. Some deformity corrections were for non-polio cases. Interesting cases in the OPD included skeletal dysplasias, rickets and congenital deformities. Conclusion: At the time where MMC restricts overseas
British military forces remain heavily committed in both Iraq and Afghanistan. A recent workload analysis from Op HERRICK identified a high surgical workload, particularly orthopaedic, under the care of a sole consultant orthopaedic surgeon. There are no orthopaedic
Introduction: Most surgeons agree on basic parameters defining a successful joint replacement procedure. However, the process of acquiring the skills to achieve this level of success on a reproducible basis is much less straightforward. In reality, it is generally not possible to impart surgical
Purpose: Few opportunities exist for physicians to easily obtain immediate insights or solicit direct advice from a respected peer on a complicated case. As a result, physicians end up relying heavily on journals, textbooks, and other dated resources that may prove to be dated or inadequate in addressing unique patient problems. Furthermore, the typical