Inducing life-like distal radius fractures in human cadaveric specimens: a tool for enhanced surgical training.


Journal

Archives of orthopaedic and trauma surgery
ISSN: 1434-3916
Titre abrégé: Arch Orthop Trauma Surg
Pays: Germany
ID NLM: 9011043

Informations de publication

Date de publication:
Mar 2020
Historique:
received: 27 09 2019
pubmed: 7 12 2019
medline: 22 8 2020
entrez: 7 12 2019
Statut: ppublish

Résumé

Surgical education consists often times of a discrepancy between necessary amount of provided operative teaching and amount of organizational and ward duties. Operative education is often cut to a minimum. As public awareness toward surgical competence raises, so must the educational system. Courses that provide pre-fractured cadaveric specimens can facilitate surgical teaching realistically, prior to operating on living patients. The aim of this study is to introduce a realistic distal radius fracture simulation setup. 12 cadaveric specimens (3 male, 9 female) were fixed onto a custom drop-test-bench in the hyperextension of the wrist. The forearm was cut midway between elbow and carpus. The distal part of the forearm was potted, and the specimen was exposed to a high energetic impulse. CT imaging was performed after fracture simulation to detect the exact fracture patterns. We used the AO/ASIF recommendations and four-corner concept to classify the achieved fractures by two independent trauma surgeons. All cadaveric specimens could be successfully fractured. 11 fractures were classified as type 23C3.2 and one was classified as type 23C3.3, as additional fracture of diaphysis occurred. Subclassification according to the four-corner concept showed all fractures to be type C. A concomitant ulnar styloid fracture was observed in 4 cases. Furthermore, all cases showed at least one fragment involving the sigmoid notch. There was no statistically significant correlation found regarding Hounsfield Units (HU) and age (p value 0.402), as well as HU and required kinetic energy (p value 0.063). A high energetic impulse induced by a custom-made drop-test bench can successfully simulate realistic distal radius fractures in cadaveric specimens with intact soft tissue. Furthermore, these pre-fractured specimens can be utilized in surgical education to provide a teaching experience as realistic as possible without harming living patients.

Identifiants

pubmed: 31807851
doi: 10.1007/s00402-019-03313-5
pii: 10.1007/s00402-019-03313-5
doi:

Types de publication

Journal Article

Langues

eng

Sous-ensembles de citation

IM

Pagination

425-432

Références

Pellegrini CA (2006) Surgical education in the United States: navigating the white waters. Ann Surg 244(3):335–342. https://doi.org/10.1097/01.sla.0000234800.08200.6c
doi: 10.1097/01.sla.0000234800.08200.6c pubmed: 16926559
Darzi SA, Munz Y (2004) The impact of minimally invasive surgical techniques. Annu Rev Med 55:223–237. https://doi.org/10.1146/annurev.med.55.091902.105248
doi: 10.1146/annurev.med.55.091902.105248 pubmed: 14746519
Depres-Tremblay G, Chevrier A, Snow M, Hurtig MB, Rodeo S, Buschmann MD (2016) Rotator cuff repair: a review of surgical techniques, animal models, and new technologies under development. J Shoulder Elbow Surg 25(12):2078–2085. https://doi.org/10.1016/j.jse.2016.06.009
doi: 10.1016/j.jse.2016.06.009 pubmed: 27554609
Pennington DG (2006) The impact of new technology on cardiothoracic surgical practice. Ann Thorac Surg 81(1):10–18. https://doi.org/10.1016/j.athoracsur.2005.11.031
doi: 10.1016/j.athoracsur.2005.11.031 pubmed: 16368328
Wegmann K, Engel K, Burkhart KJ, Ebinger M, Holz R, Bruggemann GP, Muller LP (2014) Sequence of the Essex-Lopresti lesion—a high-speed video documentation and kinematic analysis. Acta Orthop 85(2):177–180. https://doi.org/10.3109/17453674.2014.887952
doi: 10.3109/17453674.2014.887952 pubmed: 24479620
Nellans KW, Kowalski E, Chung KC (2012) The epidemiology of distal radius fractures. Hand Clinics 28(2):113. https://doi.org/10.1016/j.hcl.2012.02.001
doi: 10.1016/j.hcl.2012.02.001 pubmed: 22554654
Unglaub F, Langer MF, Hohendorff B, Muller LP, Unglaub JM, Hahn P, Krimmer H, Spies CK (2017) Distal radius fracture of the adult. Diagnostics and therapy. Orthopade 46(1):93–110. https://doi.org/10.1007/s00132-016-3347-5
doi: 10.1007/s00132-016-3347-5 pubmed: 27815606
Quadlbauer S, Pezzei C, Jurkowitsch J, Rosenauer R, Pichler A, Schattin S, Hausner T, Leixnering M (2018) Early complications and radiological outcome after distal radius fractures stabilized by volar angular stable locking plate. Arch Orthop Trauma Surg 138(12):1773–1782. https://doi.org/10.1007/s00402-018-3051-5
doi: 10.1007/s00402-018-3051-5
Pillukat T, Fuhrmann R, Windolf J, van Schoonhoven J (2016) The volar locking plate for extension fractures of the distal radius. Oper Orthop Traumato 28(1):47–63. https://doi.org/10.1007/s00064-015-0433-5
doi: 10.1007/s00064-015-0433-5
Erhart S, Toth S, Kaiser P, Kastenberger T, Deml C, Arora R (2018) Comparison of volarly and dorsally displaced distal radius fracture treated by volar locking plate fixation. Arch Orthop Trauma Surg 138(6):879–885. https://doi.org/10.1007/s00402-018-2925-x
doi: 10.1007/s00402-018-2925-x pubmed: 29696363
Gologan RE, Koeck M, Suda AJ, Obertacke U (2019) > 10-year outcome of dislocated radial fractures with concomitant intracarpal lesions as proven by MRI and CT. Arch Orthop Trauma Surg 139(6):877–881. https://doi.org/10.1007/s00402-019-03186-8
doi: 10.1007/s00402-019-03186-8 pubmed: 30972480
Schnetzke M, Fuchs J, Vetter SY, Swartman B, Keil H, Grutzner PA, Franke J (2018) Intraoperative three-dimensional imaging in the treatment of distal radius fractures. Arch Orthop Trauma Surg 138(4):487–493. https://doi.org/10.1007/s00402-018-2867-3
doi: 10.1007/s00402-018-2867-3 pubmed: 29322319
Diwersi N, Babst R, Link BC (2016) Miniplates as augmentation implants in osteosynthesis of complex distal radial fractures. Oper Orthop Traumato 28(5):402–406. https://doi.org/10.1007/s00064-016-0469-1
doi: 10.1007/s00064-016-0469-1
Wegmann K, Rausch V, Burkhart KJ, Hackl M, Leschinger T, Muller L (2019) Advanced surgical trauma care course – evaluation of a fracture simulation course concept with intact soft tissue. Z Orthop Unfall. https://doi.org/10.1055/a-0983-8322
doi: 10.1055/a-0983-8322 pubmed: 31533163
Lee S, Chung CK, Oh SH, Park SB (2013) Correlation between bone mineral density measured by dual-energy X-ray absorptiometry and Hounsfield units measured by diagnostic CT in lumbar spine. J Korean Neurosurg S 54(5):384–389. https://doi.org/10.3340/jkns.2013.54.5.384
doi: 10.3340/jkns.2013.54.5.384
Patel SP, Lee JJ, Hecht GG, Holcombe SA, Wang SC, Goulet JA (2016) Normative vertebral Hounsfield unit values and correlation with bone mineral density. J Clin Exp Orthopaed 2(114):1–7
Schreiber JJ, Anderson PA, Hsu WK (2014) Use of computed tomography for assessing bone mineral density. Neurosurg Focus. https://doi.org/10.3171/2014.5.Focus1483
doi: 10.3171/2014.5.Focus1483 pubmed: 24981903
Wagner SC, Dworak TC, Grimm PD, Balazs GC, Tintle SM (2017) Measurement of distal ulnar Hounsfield units accurately predicts bone mineral density of the forearm. J Bone Joint Surg. https://doi.org/10.2106/JBJS.15.01244
doi: 10.2106/JBJS.15.01244 pubmed: 29257012
Dworak TC, Wagner SC, Nappo KE, Balazs GC, Grimm PD, Colantonio DF, Tintle SM (2018) The use of distal Ulnar Hounsfield units to predict future fragility fracture risk. J Hand Surg-Am 43(11):1010–1015. https://doi.org/10.1016/j.jhsa.2018.04.017
doi: 10.1016/j.jhsa.2018.04.017 pubmed: 29891269
Müller ME (1991) The principle of the classification. In: Müller ME, Allgöwer M, Schneider R, Willenegger H (eds) Manual of internal fixation: techniques recommended by the AO-ASIF group, 3rd edn. Springer, New York, p 118
doi: 10.1007/978-3-662-02695-3
Brink PRG, Rikli DA (2016) Four-corner concept: CT-based assessment of fracture patterns in distal radius. J Wrist Surg 5(2):147–151. https://doi.org/10.1055/s-0035-1570462
doi: 10.1055/s-0035-1570462 pubmed: 27104082 pmcid: 4838463
Court-Brown CM, Caesar B (2006) Epidemiology of adult fractures: a review. Injury 37(8):691–697. https://doi.org/10.1016/j.injury.2006.04.130
doi: 10.1016/j.injury.2006.04.130 pubmed: 16814787
Melone CP (1984) Articular fractures of the distal radius. Orthop Clin N A 15(2):217–236
Augat P, Iida H, Jiang Y, Diao E, Genant HK (1998) Distal radius fractures: mechanisms of injury and strength prediction by bone mineral assessment. J Orthop Res 16(5):629–635. https://doi.org/10.1002/jor.1100160517
doi: 10.1002/jor.1100160517 pubmed: 9820289
Koebke J (1988) Anatomy of the wrist joint and carpus. Unfallchirurgie 14(2):74–79
pubmed: 3291357
Atesok K, Mabrey JD, Jazrawi LM, Egol KA (2012) Surgical simulation in orthopaedic skills training. J Am Acad Orthop Sur 20(7):410–422. https://doi.org/10.5435/Jaaos-20-06-410
doi: 10.5435/Jaaos-20-06-410
Nutt J, Mehdian R, Parkin I, Dent J, Kellett C (2012) Cadaveric surgery: a novel approach to teaching clinical anatomy. Clin Teach 9(3):148–151. https://doi.org/10.1111/j.1743-498X.2012.00536.x
doi: 10.1111/j.1743-498X.2012.00536.x pubmed: 22587312
Holland JP, Waugh L, Horgan A, Paleri V, Deehan DJ (2011) Cadaveric hands-on training for surgical specialties: is this back to the future for surgical skills development? J Surg Educ 68(2):110–116. https://doi.org/10.1016/j.jsurg.2010.10.002
doi: 10.1016/j.jsurg.2010.10.002 pubmed: 21338966
Sharma G, Aycart MA, Najjar PA, van Houten T, Smink DS, Askari R, Gates JD (2016) A cadaveric procedural anatomy course enhances operative competence. J Surg Res 201(1):22–28. https://doi.org/10.1016/j.jss.2015.09.037
doi: 10.1016/j.jss.2015.09.037 pubmed: 26850180
Katz R, Hoznek A, Antiphon P, Van Velthoven R, Delmas V, Abbou CC (2003) Cadaveric versus porcine models in urological laparoscopic training. Urol Int 71(3):310–315. https://doi.org/10.1159/000072684
doi: 10.1159/000072684 pubmed: 14512654
Kuhls DA, Risucci DA, Bowyer MW, Luchette FA (2013) Advanced surgical skills for exposure in trauma: a new surgical skills cadaver course for surgery residents and fellows. J Trauma Acute Care Surg 74(2):664–670. https://doi.org/10.1097/TA.0b013e31827d5e20
doi: 10.1097/TA.0b013e31827d5e20 pubmed: 23354267
Garment A, Lederer S, Rogers N, Boult L (2007) Let the dead teach the living: the rise of body bequeathal in 20th-century America. Acad Med 82(10):1000–1005. https://doi.org/10.1097/ACM.0b013e318149e986
doi: 10.1097/ACM.0b013e318149e986 pubmed: 17895666
Christophel JJ, Park SS, Nogan SJ, Essig GF (2017) A facial trauma simulation course for evaluation and treatment of facial fractures. Jama Facial Plast Surg 19(6):464–467. https://doi.org/10.1001/jamafacial.2017.0313
doi: 10.1001/jamafacial.2017.0313 pubmed: 28594983
Gilbody J, Prasthofer AW, Ho K, Costa ML (2011) The use and effectiveness of cadaveric workshops in higher surgical training: a systematic review. Ann R Coll Surg Engl 93(5):347–352. https://doi.org/10.1308/147870811X582954
doi: 10.1308/147870811X582954 pubmed: 21943455

Auteurs

Kilian Wegmann (K)

Faculty of Medicine and University Hospital, Center for Orthopedic and Trauma Surgery, University of Cologne, Kerpener Str. 62, 50937, Cologne, Germany.

Andreas Harbrecht (A)

Faculty of Medicine and University Hospital, Center for Orthopedic and Trauma Surgery, University of Cologne, Kerpener Str. 62, 50937, Cologne, Germany. andreas.harbrecht@uk-koeln.de.
Department of Anatomy I, Medical Faculty, University of Cologne, Cologne, Germany. andreas.harbrecht@uk-koeln.de.

Michael Hackl (M)

Faculty of Medicine and University Hospital, Center for Orthopedic and Trauma Surgery, University of Cologne, Kerpener Str. 62, 50937, Cologne, Germany.

Stephan Uschok (S)

Faculty of Medicine and University Hospital, Center for Orthopedic and Trauma Surgery, University of Cologne, Kerpener Str. 62, 50937, Cologne, Germany.

Tim Leschinger (T)

Faculty of Medicine and University Hospital, Center for Orthopedic and Trauma Surgery, University of Cologne, Kerpener Str. 62, 50937, Cologne, Germany.

Lars P Müller (LP)

Faculty of Medicine and University Hospital, Center for Orthopedic and Trauma Surgery, University of Cologne, Kerpener Str. 62, 50937, Cologne, Germany.

Articles similaires

[Redispensing of expensive oral anticancer medicines: a practical application].

Lisanne N van Merendonk, Kübra Akgöl, Bastiaan Nuijen
1.00
Humans Antineoplastic Agents Administration, Oral Drug Costs Counterfeit Drugs

Smoking Cessation and Incident Cardiovascular Disease.

Jun Hwan Cho, Seung Yong Shin, Hoseob Kim et al.
1.00
Humans Male Smoking Cessation Cardiovascular Diseases Female
Humans United States Aged Cross-Sectional Studies Medicare Part C
1.00
Humans Yoga Low Back Pain Female Male

Classifications MeSH