Carol Hutchison

Assessment of technical skills transfer from the bench training model to the human model.

BACKGROUND This study examines whether technical skills learned on a bench model are transferable to the human cadaver model. METHODS Twenty-three first-year residents were randomly assigned to three groups receiving teaching on six procedures. For each procedure, one group received training on a cadaver model, one received training on a bench model, and one learned independently from a prepared text. Following training, all residents were assessed on their ability to perform the six procedures. RESULTS Repeated measures analysis of variance revealed a significant effect of training modality for both checklist scores (F(2,44) = 3.49, P <0.05) and global scores (F(2,44) = 7.48, P <0.01). Post-hoc tests indicated that both bench and cadaver training were superior to text learning and that bench and cadaver training were equivalent. CONCLUSIONS Training on a bench model transfers well to the human model, suggesting strong potential for transfer to the operating room.

Osteochondral defects of the talus treated with fresh osteochondral allograft transplantation.

Between 1980 and 1996, 9 patients with osteocartilagenous lesions of the talus were treated surgically using fresh osteochondral allograft transplantation. In 8 cases the reason for surgery was osteochondritis dissecans (4 of these cases had a previous traumatic injury). In 1 case a fresh osteochondral allograft of the talus was required following a traumatic open fracture of the talus sustained in a motor vehicle accident. Of these 9 grafts, 6 grafts remain in situ with a mean survival of 11 years (range 4 to 19). In the three cases requiring fusion the reason for surgery was not related to arthritic deterioration but due to resorption and fragmentation of the graft.

Proximal femoral allografts for reconstruction of bone stock in revision arthroplasty of the hip. A nine to fifteen-year follow-up.

Proximal femoral allografts have been used to restore uncontained circumferential defects of the multiply revised total hip arthroplasty. These grafts are used with long stem components that are cemented to the graft but not the host. The junction of host and graft is stabilized by the stem and a step cut with cerclage wires. Autograft bone is placed at the junctions to induce union. Full weightbearing is delayed until union occurs between the graft and the host femur, usually by 3 months. One hundred sixty-eight structural femoral allografts were done; average followup was 4.8 years as of January 1, 1995. Success was defined as an increase in the clinical score of at least 20 points, a stable implant, and no need for further surgery related to the allograft. The success rate in 130 patients with at least 2 years followup is 85%. There have been 17 revisions in 16 patients: 3 revisions for infection, 8 for dislocation, 5 for nonunion, and 1 for pain. The revision rate is 10.1%. Radiographic analysis showed 7 nonunions, minor resorption in 6 patients, and significant resorption in 1 patient. All implants are stable with no lucent lines. The results support using this technique for full circumferential segmental proximal femoral defects in revision hip arthroplasty.

Evaluating the effectiveness of a 2-year curriculum in a surgical skills center

BACKGROUND This study was a formative evaluation of a 2-year Surgical Skills Center Curriculum (SSCC) using objective measures of surgical performance and self-reported process-oriented evaluations. METHODS Fifty postgraduate third-year (PGY-3) residents participated in an Objective Structured Assessment of Technical Skills (OSATS) examination. Nineteen residents underwent the SSCC and 31 residents did not. During the SSCC, self-reported student and faculty evaluations were completed after each session. RESULTS For the OSATS examination, scores were not significantly different between treatment and control groups, on either the checklist (66.4 +/- 6.1 versus 64.1 +/- 10.8) or global rating scale scores (66.9 +/- 6.9 versus 68.0 +/- 9.6). Further comparisons between groups on individual OSATS stations revealed no significant differences between groups. The majority of student and faculty evaluation remarks were highly positive. CONCLUSIONS The OSATS results failed to support our hypothesis that training on a core procedure in a single session during a SSCC would have an appreciable and sustained effect after 2 years. Self-reported process-oriented evaluations support the utility of our SSCC.

Proximal femoral allografts for reconstruction of bone stock in revision arthroplasty of the hip.

Full circumferential bone loss of the proximal femur can be managed by segmental allografts. The use of these grafts is indicated for uncontained defects longer than five cm in length. The femoral implant is cemented into the allograft but not into the host. The allograft host junction is stabilized by a step cut or oblique osteotomy and autografted with residual host femur. The results at five and nine years support this kind of reconstruction as a good alternative for this difficult problem.

Instructional Course Lectures, The American Academy of Orthopaedic Surgeons - Femoral Bone Loss in Patients Managed with Revision Hip Replacement: Results of Circumferential Allograft Replacement*†

Surgeons who perform reconstructive procedures about the hip are faced increasingly with complex cases in which severe loss of bone makes conventional revision techniques difficult or impossible18,47,48,51,90,91. In such situations, one alternative is the use of a composite consisting of a proximal femoral allograft and a prosthesis to restore mechanical integrity to the proximal part of the femur. This technique has attracted increased attention because of its potential for reconstituting bone stock in young patients96 and because the allograft-cement-implant composite is a strong reconstruction that does not require sacrifice of host tissue and theoretically improves the bone stock for future reconstructions. Allografts also have been used in revision hip arthroplasty to replace or reinforce the calcar24,47,48,60 and to treat or prevent periprosthetic fractures16,17,40,62. The present study concentrates on the indications, biological mechanisms, techniques, and results associated with use of circumferential proximal femoral allografts in the revision of a failed total hip replacement. ### History In 1908, Lexer76 reported on what we believe was the first series of patients managed with allograft transplantation; twenty-three whole joints and eleven hemijoints were used. Lexer subsequently reported the results in 192577. After the excellent work of Bonfiglio et al.6, Chase and Herndon19, and Curtiss et al.20 on the immunogenicity of frozen allografts, interest in the use of bulk allografts was rekindled in the late 1960s and early 1970s. This work centered on the reconstruction of defects after excision of a tumor101,102,105,106 and led to larger series, such as that reported on by Mankin et al.85. With the success of such limb-sparing …

The Effectiveness of a Technical Skills Course for Surgical Residents

This study investigates the impact of technical skills courses on first year surgical residents’ performance. Three issues were investigated: 1) the degree of performance improvement, 2) the duration of improvement, 3) the transfer of performance improvement to similar tasks. Twenty-four PGY1 surgical residents were randomized into 2 groups and 12 PGY5 orthopaedic residents were the gold standard. All groups completed a pretest consisting of 2 pairs of surgical tasks: 1) plating and k-wire fixation of a metacarpal fracture and 2) application of a forearm and below-knee plaster. Half of the PGY1 s had a course on plating a metacarpal fracture and half were given a course on application of a forearm plaster. One week postcourse, all residents were retested on the 4 tasks. Six weeks postcourse all PGY1s were retested. Pretest results showed that PGY1s were performing significantly below the PGY5 group on all tasks. When trained on a procedure, the PGY1 groups performance equalled the PGYSs’ and was significantly better than the PGY1 group that received no training. This significant difference was maintained over 6 weeks. However, performance on the tasks sharing similar basic principles did not show any improvement over the pretest scores with the performance of both PGY1 groups remaining significantly below that of the PGY5 group. Focused technical skills courses can result in substantial performance improvements. The effect can last 6 weeks. However, performance did not transfer to other tasks requiring similar basic skills.