Results from an expedited spinal nerve root block clinic at a UK tertiary neurosurgical centre.

STUDY DESIGN: Retrospective Observational Study. INTRODUCTION: Lumbar radicular pain has a prevalence of 3-5%. Level 1 evidence has demonstrated equivalence between surgical and injection treatment. We assess the outcomes from a transforaminal epidural steroid injection clinic in a tertiary neuroscience referral centre. METHODS: We performed an analysis of data from consecutive patients entered into a new internal referral database between August 2018 to May 2021. Radicular pain was classified as one of "first presentation" or "recurrence". Outcomes were obtained from follow up clinic letters and recorded in a binary manner of "positive result" or "negative result". Spinal pathology was documented from radiology reports and MRI images. RESULTS: We analysed 208 patients referred to the clinic. Excluding those who improved to a point of not requiring treatment, and those who underwent surgical intervention, 119 patients undergoing injection were included, of which 14 were lost to follow-up. 68 % of patients had a positive result from injection. Subgroup analysis demonstrated good outcomes for both hyperacute (<6 weeks) and chronic (>12 months). Contained disk pathologies had better outcomes than uncontained. There was no difference in outcomes across grades of compression, but previous same level surgery was associated with poorer response rates. CONCLUSIONS: There is a high rate of natural resolution of symptoms in patients with LSRP. In those where pain persists, TFESI is a valuable first line treatment modality. This study suggests the efficacy of TFESI is potentially independent of grade of stenosis and chronicity of symptoms. Contained disc pathologies respond better than uncontained.

Extended-Duration Work Shifts in Surgical Specialties: A Systematic Review.

INTRODUCTION: There has been widespread international implementation of duration-hour restrictions to prevent surgical resident burnout and promote patient safety and wellbeing of doctors. A variety of Extended-Duration Work Shifts (EDWS) have been implemented, with a variety of studies examining the effect of shift systems on both surgical performance and the stress response unestablished in the literature. METHODS: This was a systematic review evaluating the impact of extended working hours on surgical performance, cognitive impairment, and physiological stress responses. The review used PubMed, Ovid Medline, Embase, and Google Scholar search engines between September and October 2021 in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Filters including studies carried out after 2002 and published in the English language were applied. RESULTS: In total, 30 studies were included for analysis. General surgery was the most commonly studied rotation, with Neurosurgical, Orthopedic, and ear, nose and throat specialties also included. The majority of studies found no difference or a significant improvement in post-EDWS on simulated performance. EDWS appeared to have the greatest impact on physiological stress markers in junior surgical trainees. CONCLUSIONS: Experience appears to confer a protective element in the postcall period, with preservation of skill demonstrated. More experienced clinicians yielded lower levels of physiological markers of stress, although variability in hierarchical workload should be considered. Heterogeneity of findings across physiological, cognitive, and psychomotor assessments highlights the need for robust research on the optimum shift pattern prevents worker burnout and promotes patient safety. Future research to evaluate correlation between stress, on-call workload, and performance in the postcall period is warranted.

Impact of Mentoring for Underrepresented Groups in Undergraduate Medical Education: A Systematic Review.

OBJECTIVES: Despite efforts to mitigate challenges to advance underrepresented groups (URG) groups' representation in medical education, diversity remains underwhelming. In response to this several mentoring programs to increase diversification within medical education have been implemented. However, the impact of these programs on URG representation across disciplines is unknown. The aim of this review is to evaluate the impact of structured mentoring programs on URGs in undergraduate medical education. DESIGN: Systematic review. METHODS: A comprehensive search strategy was performed of electronic databases including PubMed, Ovid Medline, and EMBASE between January and September 2022 in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Both qualitative and quantitative outcomes including characteristics of the mentoring structure explored within each study were collected, and differences in study outcomes analyzed. RESULTS: In total 17 studies were included for analysis. Mentoring within URGs resulted in an increase in research opportunities, exam performance, medical specialty applications, and residency matching. Structured feedback yielded positive experiences by both mentors and mentees participating in programs, with both emotional and cultural competence issues explored across studies included for analysis. CONCLUSIONS: Mentoring for medical students underrepresented in medicine across mentoring relationships including peer, senior, formal, and informal structures yield positive outcomes within research, academic modules, and career pathways. Future applications of mentoring programs should consider the use of tandem mentoring from both senior and peer mentors to optimize benefits URG students derive from each mentoring relationship.

Recording adverse events following orthopaedic trauma: Financial implications and validation of an adverse event assessment form in an Irish regional trauma unit.

BACKGROUND: In Ireland, funding of orthopaedic trauma is based on an activity-based funding (ABF) model. Clinically similar cases are split into diagnostic-related groups (DRG), with base funding per DRG provided. Increased complexity of cases (length of stay; complications incurred; occurrence of adverse events) attracts additional remuneration to the base funding. In our institution these adverse events are recorded via retrospective chart-abstraction methods by administrative staff. Incidences which are not included from this review affect both follow up with family physicians and patient care; as well as skewing budgetary decisions that impact fiscal viability of the service. The aim of this study was to compare a prospectively implemented adverse events form with the current national retrospective chart abstraction method. Our outcomes in terms of pay-by-results financial implications. METHODS: An adverse events database adapted from a similar validated model was used to prospectively record complications in 216 patients admitted via the orthopaedic trauma service. Data was contemporaneously collected via a GDPR compliant secure medical messaging platform. Results were compared with the same cohort using an existing data abstraction method. Both data sets were coded in accordance with current standards for case funding. RESULTS: Overall, 49 adverse events were recorded during the study through prospective charting of adverse events, compared with 26 events documented by customary method (p<0.01).Anaemia requiring blood transfusion n = 11 22.4%) was the most common complication, followed by delirium n = 6 (12%), acute kidney injury n = 6 (12%), and pneumonia n = 5 (10.2%). Missed appropriate funding through conventional methods totalled €40,293 . CONCLUSION: This pilot study demonstrates the ability to improve capture of adverse events through use of a well-designed assessment form. Proper perioperative data handling is a critical aspect of financial subsidies, enabling optimal allocation of funds.

Surgical Priming Improves Operative Performance in Surgical Trainees: A Crossover Randomized Control Trial.

OBJECTIVE: The aim of this study was to evaluate the impact of a surgical warm-up using a virtual reality simulator on operative performance. DESIGN: This was a single-blinded cross-over randomized control trial in a single tertiary Orthopedic training center. PARTICIPANTS: Orthopedic trainees were recruited, and each morning participants rostered to theatre were randomized to either undergo a simulated surgical procedure on a virtual reality simulation system prior to their first case as primary operator (priming arm), or to perform their usual preparatory routine for surgery (control arm). Consultant orthopedic trainers were recruited within the orthopedic unit to carry out subjective surgical performance assessments using a validated global rating scale tool on the first case the participant performed on the list as primary operator. RESULTS: Over 3 study periods a total of 151 data points were collected, with 49 matched data points across priming status and procedural level of difficulty. Subjective assessment tools consistently demonstrated improved operative performance by participants following surgical priming (p = 0.001). CONCLUSION: This study highlights that introduction of preoperative priming to improve operative preparation, and optimizes operative performance. This has not only implications for improved resident training, but also signals towards beneficial downstream effects on patient outcomes, and theatre list planning.

Preoperative priming results in improved operative performance with surgical trainees.

BACKGROUND: Preoperative warm-up regimens are increasingly utilised in the surgical field, however no consensus on benefits of priming across surgical experience has been realised. The aim of this study was to evaluate the impact of simulation preoperative priming on operative performance across levels of resident experience. METHODS: A single-blinded randomised control trial was carried out in a regional surgical training centre. Volunteers were randomised to undergo simulated surgical warm-up procedure prior to their first case as primary operator or proceed directly to surgery. RESULTS: Performances of 147 operative procedures were collected over an 18 month period, experience ranging from PGY2-PGY 7. Senior participants consistently outperformed junior residents in unprimed operative cases (p = 0.005). In primed operative performances no significant difference in aggregate performance scores was found (p = 0.07). CONCLUSION: Priming confers a greater advantage to junior residents with particular regard to generic surgical skills. Senior residents demonstrate improved self-efficacy scores measured following priming.

The addition of oral Tranexamic acid to knee arthroplasty patients does not further improve blood loss: a double blinded randomized control trial.

Perioperative intravenous (IV) TA has become routine in knee and hip arthroplasty. Less evidence exists on the administration of oral TA in the post- operative period. Our study aims to identify the efficacy and safety of combined perioperative IV and post-operative oral TA on blood loss and Hemoglobin (Hb) drop compared to perioperative IV TA alone. Patients undergoing primary elective knee arthro- plasty at our institution were invited to participate in the study (n=50). A computer-generated randomisation sequence was created online (www.randomization. org), with an allocation ratio of 1:1 and a block size of 50. Group A received perioperative IV TA alone and post-operative oral TA (n= 26) and Group B received perioperative IV TA plus 48 hours additional oral placebo (n= 24). Day 3 total blood loss and Hb drop was calculated. Continuous, normally distributed data (total blood loss) was compared utilising using one-way analysis of variance with post hoc Tukey test. Continuous skewed data (Hb drop) was compared using the Kruskal-Wallis test. P <0.05 was considered statistically significant. Group A demonstrated a trend in decreased total blood loss that was close to statistical significance ( p = 0.072). No difference in Hb drop was identified between the 2 groups. Increased nausea was also observed in Group A. The administration of oral TA to post-operative knee arthroplasty patients does not improve further blood loss compared to patients receiving perioperative IV TA pre-operatively and at wound closure.

Evaluating the Impact of Supervision on Surgical Trainees Stress Response During Simulated Surgical Procedures; A Crossover Randomized Trial.

OBJECTIVE: The aim of this study was to evaluate the cumulative impact of supervision on technical skills and surrogate stress markers in surgical trainees. DESIGN: This was a quasi-experimental crossover study to evaluate the impact of attending supervision on orthopedic trainee stress response during a simulated surgical procedure. Enrolled residents performed a proximal femoral nail module with the Precision OS system twice; once independently, and once under direct attending supervision, whilst wearing a heart rate monitor. Mean and maximum heart rates were recorded. Simulated performance was assessed using validated simulator-based metrics. Student's t-test was used to evaluate the impact of supervision on trainee heart rate, and performance ranking. SETTING: Tertiary trauma center in a Regional Orthopedic Unit PARTICIPANTS: Orthopedic interns and residents within our institution were invited to participate, with 20 participants included for analysis. RESULTS: Both supervised and unsupervised mean heart rate was significantly higher (p = 0.001) than baseline recorded heart rates. Supervised mean and maximum HR were significantly higher than unsupervised HR during module completion (p = 0.015; p = 0.001). Calories burned demonstrated correlation to surrogate stress markers, significantly higher in supervised sessions (p = 0.004). Performance metrics demonstrated superior performance in senior-level participants, with a decrement in performance during supervision, failing to reach significance. CONCLUSION: The development of accretion of technical and non-technical skills required in surgical training pathways may derive benefit from the use of simulation-based training in surgical residents with both supervised and unsupervised sessions.

Use of procedure specific preoperative warm-up during surgical priming improves operative outcomes: A systematic review.

BACKGROUND: Preoperative warm-up in preparation for surgery is a technique used in recognition of similarities between surgeons and performance based professionals. The aim of this review was to evaluate the use of simulation-based preoperative warm-up on surgical performance in the operating room and its impact on both clinical and patient outcomes. MATERIALS AND METHODS: A systematic review of the literature was carried out in accordance with PRISMA guidelines between August-September 2021. In total 15 studies were retrieved. RESULTS: Seven studies across general surgery, urology, and vascular surgery used a procedure specific warm-up, with significant improvement in operative performance, rate of errors, radiological and patient-based outcomes. Variables including level of experience and specialty appeared to have no impact on the merits of preoperative warm-up demonstrated. CONCLUSIONS: While heterogeneity in the benefit of generic warm-up procedures was noted, procedure specific warm-up methods consistently resulted in significantly better operative outcomes.

Rates of complications in Achilles tendon rupture repair using absorbable and nonabsorbable suture material; A systematic review.

BACKGROUND: The impact of suture type on tensile strength, re-rupture rates and infection risk in Achilles tendon rupture repair is not been well established. The aim of this review is to evaluate existing literature on the associated risk of postoperative infection with absorbable and non-absorbable suture materials in Achilles tendon rupture repair. METHODS: A systematic review of search databases PubMed; Google Scholar; and OVID Medline was made to identify studies related to complications associated with Achilles tendon rupture repair. PRISMA guidelines were utilised for this review. Meta-analysis was used to compare rupture rates and infections following rupture repair. RESULTS: 12 studies with a total of 460 patients, 230 in both nonabsorbable and absorbable suture groups were included for analysis. Risk of wound complications was significantly higher in patients with non-absorbable sutures (p < 0.001). CONCLUSION: Nonabsorbable braided sutures is associated with the highest risk of postoperative wound complications following Achilles tendon rupture repair.

Hand dominance and experience improve bimanual performance on arthroscopic simulator task.

PURPOSE: The aim of this study was to identify if experience in arthroscopy confers ambidexterity to the operator and the role of baseline characteristics in arthroscopic simulator performance. METHODS: A prospective comparative study was carried out across four regional Orthopaedic training centres. Participants were divided into novice, intermediate or experienced groups based on arthroscopic experience. Baseline demographics including age, sex, handedness, and gaming history were also collected. Following familiarisation with the procedure, participants were asked to complete a simulated task requiring bimanual control consisting of visualisation with camera control and manipulation of highlighted objects using a grasping instrument. One attempt using camera control and grasping accuracy per hand was performed by each participant, with scores for each hand collected for analysis. Performance scores for camera alignment, camera path length, grasper path length and grasping efficiency were collected. Time taken to completion was also noted for each attempt. RESULTS: Fifty-six participants were recruited to the study. A significant difference in grasping efficiency between groups in the dominant hand was demonstrated (p = 0.013). Novices demonstrated laterality with superior performance in grasping efficiency in the dominant hand (p = 0.001). No significant difference was noted between dominant and non-dominant hand performance in the experienced group. CONCLUSION: Arthroscopic simulation-based training is a valuable learning tool for orthopaedic training. This study demonstrated that experienced orthopaedic surgeons have a greater degree of ambidexterity than intermediate or novice groups, hypothesised by authors to be conferred through conventional orthopaedic training. Dedicated bimanual control tasks to reduce laterality in trainees should be incorporated in simulated surgical curricula. LEVEL OF EVIDENCE: III.

Obesity: An Independent Risk Factor for Complications in Anterior Lumbar Interbody Fusion? A Systematic Review.

STUDY DESIGN: Systematic Review and Meta-analysis. OBJECTIVES: Raised patient BMI is recognised as a relative contraindication to posterior lumbar interbody fusion (PLIF) due to the anaesthetic challenges, difficult positioning and increased intraoperative and postoperative complications, with the relative risk rising in patients with a BMI >25 kg/m2. The impact of obesity defined as a BMI > 30 kg/m2 on Anterior Lumbar Interbody Fusion (ALIF) outcomes is not yet established. The aim of this review was to evaluate if the presence of a raised BMI in patients undergoing ALIF procedures was an independent risk factor for intra- and postoperative complications. METHODS: A systematic review of search databases PubMed; Google Scholar and OVID Medline was made to identify studies related to complications in patients with increased body mass index during anterior lumbar interbody fusion. PRISMA guidelines were utilised for this review. Complication rates in raised BMI patient cohort was compared to normal BMI complication rates with meta-analysis where available. RESULTS: 315 articles returned with search criteria applied. Six articles were included for review, with 2190 patients included for analysis. Vascular complications in obese vs. non-obese patients undergoing the anterior approach demonstrate no significant difference in complication rates (P = .62; CI = -.03-.02). Obesity is found to result in an increased rate of overall complications (P = .002; CI = .04-.16). CONCLUSIONS: Obesity was demonstrated to have an impact on overall complication rates in Anterior Lumbar Interbody Fusion procedures, with postoperative complications including wound infections and lower fusion rates more common in patients in increased BMIs. Increased focus on patient positioning and reporting of outcomes in this patient cohort is warranted to further evaluate perioperative complications.

The specialty mentor effect in enhancing surgical experience of medical students: A randomised control trial.

INTRODUCTION: The positive learning experiences of students on surgical rotations which subsequently influence career choice may be delineated into practical and interpersonal themed factors. It remains unclear the relative impact each component has on the student experience and subsequent specialisation. AIMS: We evaluate the influence of having senior resident mentor during practical simulation in orthopaedic surgery has on medical student interest in surgery; their comfort in theatre; and its role in enhancing knowledge acquisition within the rotation. METHODS: Medical students undergoing clinical rotations in a Regional University Hospital were randomised to undertaking a virtual reality simulated operation independently or performing under the guidance of an experienced resident. Baseline levels of interest in surgery, comfort in theatre, perceived barriers to surgical learning and entry to surgery were established and compared to answers following completion of the tutorial. Qualitative feedback was collected regarding the benefits and limitations to the experience. Presented according to CONSORT guidelines. RESULTS: Participants in the trainee guided group achieved significantly higher simulated performance scores compared to the control (p < 0001), with an increase in interest in orthopaedic surgery from baseline expressed to a statistically significant degree (p = 0.01). Participants in the unsupervised group demonstrated no significant increase in interest in Orthopaedic surgery (p = 0.3). 100% participants strongly agreed it was a beneficial learning experience which would be useful in surgical curricula. CONCLUSION: Surgical trainee guided simulation led to improved performance and interest in orthopaedic surgery, while virtual practical experience was felt to be a useful learning tool independent of supervision. Further research is needed to establish the role of interpersonal interactions in student surgical experience.

Student Acceptance of Virtual Bedside Surgical Tutorials During COVID-19: A Randomized Controlled Trial.

BACKGROUND: The social distancing recommendations from the WHO during the pandemic has resulted in a pivot point in the delivery of medical education. With the medical student clinical experience constantly under threat; novel methods to maintain adequate surgical patient exposure and student interaction on a platform amenable to the interactive format required were devised using a virtual platform to compliment current pedagogical approaches. METHODS: A parallel randomized controlled trial evaluated the perceived use of remote learning in place of bedside teaching. Participants were randomized to undergo surgical bedside teaching in person or virtually. Feedback questionnaires and exit interviews carried out following each session. Content analysis of transcripts was performed to evaluate the presence and quality of perceived learning, benefits and limitations to each modality. RESULTS: Feedback demonstrated greater engagement, satisfaction, involvement and learning (P < 0.001) in the bedside teaching group. Content analysis yielded three main themes; Technological, Interpersonal Component, Provision of Content. Participants in the virtual group reported a limited ability to elicit clinically relevant findings in surgical patients. Students however reported the virtual teaching was an acceptable method of learning with 90% satisfaction reported for learning via the virtual platform. DISCUSSION: The pandemic posed challenges to adequate student-patient exposure. Delivering surgical bedside teaching remotely is a method amenable to learning for students, with advantages including convenience, fewer reports of information fatigue, and decreased perceived pressure identified with this learning modality.

Under viral attack: An orthopaedic response to challenges faced by regional referral centres during a national cyber-attack.

BACKGROUND: A national ransomware attack on the Irish Health Service Executive left the Healthcare system bereft of access to IT systems, electronic patient records, and the national imaging system. Widespread disruption to internal and external referral pathways, and both trauma and elective Orthopaedic services occurred as a result. The purpose of this paper to discuss the challenges faced by Regional trauma units and adjustments made to overcome these. METHODS: Issues occurring as a result of the IT cybersecurity attack were discussed at regional level. Local and specialist centre adaptations were collated to identify effective modifications to established practice in the wake of the IT attack. RESULTS: The main areas affecting Orthopaedic regional practice were identified, including internal referrals, interhospital referrals to both regional and specialist centres, outpatient clinics, and elective practice. Strategies to overcome these were collated and shared between regional centres, including the use of secure messaging systems to safely transmit relevant clinical information between services, use of radiological hard copies, and integration of imaging resources to the outpatient department to expedite clinical review. CONCLUSION: The national cyberattack necessitated rapid adaptations to overcome the challenges faced as a result of reduced clinical and radiological access. While the recent cyberattack highlights the vulnerability of electronic systems, and the need for vigilance including staff training on cybersecurity; Changes implemented by regional centres also illustrate the potential for further development and expansion of current clinical practices.

Acquisition of Surgical Skills in Medical Students via Telementoring: A Randomized Controlled Trial.

BACKGROUND: Pandemic related changes have radically altered the delivery of medical teaching. The practical skills of medicine which students should be proficient in at time of graduation have tended to require in-person tutelage, with reduced access resulting in the risk of skill deficits in newly qualified doctors. Small group teaching sessions are amenable to a virtual mode of delivery, with the ability of the virtual platform to confer practical skills unproven. The objective of the study was to evaluate the use of teleproctoring in acquisition of suturing skills in medical students. METHODS: This was a single blinded two- armed randomized control trial. Medical students undergoing clinical rotations in their penultimate and final years who were able to complete the suturing tutorial were invited to participate in this study. Control groups underwent conventional suturing training under direct supervision, with the interventional group undergoing the tutorial in a remote learning setting via live streaming. Pre- and post-test assessment was carried out using validated suturing Global Rating Scale tool. RESULTS: A total of 24 participants were recruited, with 23 participants completing the task. Adequacy of sampling was demonstrated in both groups using Box's M test (P = 0.9). Participants' individual and composite scores were comparable at baseline (P = 0.28) and following the tutorial (P = 0.52). Participants improved to a statistically significant degree regardless of method of teaching delivery, in all skill parameters (P < 0.001). CONCLUSIONS: Teleproctoring is an effective tool in the provision of teaching basic suturing skills in medical students. Research on its use in more complex practical skills is warranted.

Use of biomaterials in scaphoid fracture fixation, a systematic review.

BACKGROUND: Scaphoid fractures account for 60-70% carpal injury. Due to limited vascular supply achieving adequate reduction and healing is important to avoid complications including avascular necrosis. Recent technological advances have led to renewed vigour in bioabsorbable material research to develop devices which could be used without the need for removal and complications including stress shielding and suboptimal imaging. METHODS: A systematic search of databases including PubMed, Ovid Medline, and Google Scholar databases was made to identify studies related to the use of bioabsorbable materials in scaphoid fixation and postoperative patient outcomes. PRISMA guidelines were utilised for this review. FINDINGS: Initial search results yielded 852 studies. 124 studies were screened, with 79 patients across 7 studies included in this review. Poly-L-Lactic acid derivatives were the most common biomaterial for scaphoid fixation, with magnesium and polyglycolide also used. Levels of evidence for studies ranged between III-IV. Analysis demonstrated mixed findings with generally comparable outcomes to conventional alloy-based screws. INTERPRETATION: Development in bioabsorbable materials is ongoing, however there remains a dearth in data regarding their use in the scaphoid. Further research is needed to establish the efficacy and applicability of bioabsorbable devices in the scaphoid bone.

Is there a variance in complication types associated with ALIF approaches? A systematic review.

PURPOSE: Anterior lumbar interbody fusion (ALIF) is a well-established alternative to posterior-based interbody fusion techniques, with approach variations, such as retroperitoneal, transperitoneal, open, and laparoscopic well described. Variable rates of complications for each approach have been enumerated in the literature. The purpose of this study was to elucidate the comparative rates of complications across approach type. METHODS: A systematic review of search databases PubMed, Google Scholar, and OVID Medline was made to identify studies related to complication-associated ALIF. PRISMA guidelines were utilised for this review. Meta-analysis was used to compare intraoperative and postoperative complications with ALIF for each approach. RESULTS: A total of 4575 studies were identified, with 5728 patients across 31 studies included for review following application of inclusion and exclusion criteria. Meta-analysis demonstrated the transperitoneal approach resulted in higher rates of retrograde ejaculation (RE) (p < 0.001; CI = 0.05-0.21) and overall rates of complications (p = 0.05; CI = 0.00-0.23). Rates of RE were higher at the L5/S1 intervertebral level. Rates of vessel injury were not significantly higher in either approach method (p = 0.89; CI = - 0.04-0.07). Rates of visceral injury did not appear to be related to approach method. Laparoscopic approaches resulted in shorter inpatient stays (p = 0.01). CONCLUSION: Despite the transperitoneal approach being comparatively underpowered, its use appears to result in a significantly higher rate of intraoperative and postoperative complications, although confounders including use of bone morphogenetic protein (BMP) and spinal level should be considered. Laparoscopic approaches resulted in shorter hospital stays; however, its steep learning curve and longer operative time have deterred surgeons from its widespread adaptation.

Injuries associated with arm wrestling: A narrative review.

OBJECTIVE: Arm wrestling is common sport amongst amateur enthusiasts. Multiple injuries are described as a result of the sport. The authors present a narrative review of the common injuries associated with the sport. DESIGN: Systematic review with a critical appraisal of the literature and a narrative review of the injuries associated with arm wrestling. DATA SOURCES: Seven electronic databases were systematically searched using medical subject headings (MeSH) terms as follows. Arm wrestling, Indian Wrestling, Fractures, Injury, Ligament Injury with Boolean search terms "AND". An extensive review of orthopaedic textbooks was also performed. ELIGIBILITY CRITERIA FOR SELECTING STUDIES: Inclusion criteria were publications which included patients who suffered bony or soft tissue injuries as a result of arm wrestling published in English language. RESULTS: A total of 152 patients was seen across all studies. Spiral fractures of the distal third of the humerus are by far the most common injury reported in the setting of arm wrestling. The humerus fails due torsional and bending stresses. 23% were complicated by medial butterfly fragment and the incidence of radial nerve palsy was 23%. Fracture patterns differ in the skeletally immature arm wrestler, who show an increased incidence of medial humeral epicondyle fractures. We also report on the atypical fracture and soft tissue injury patterns that present.

A pilot study to evaluate the face & construct validity of an orthopaedic virtual reality simulator.

AIMS: This study aimed to identify the face and construct validity of the Precision OS trauma module proximal femoral nail procedure. Secondary outcomes included perceived use of simulation in surgical training, with structured feedback from participants. METHODS: A comparative interventional study was carried out in a regional orthopaedics trauma unit hospital. Volunteers were stratified into novice, intermediate and expert groups based on self-reported levels of experience. Each participant carried out a simulated proximal femoral nail on an immersive virtual platform following instruction on its use, with objective metrics such as time and x-rays, and novel metrics calculated by the simulation module recorded. Face validity was also assessed. RESULTS: The proximal femoral nail module demonstrated construct validity. Kruskal Wallis test demonstrated a statistically significant difference across all group's novel performance (p=.018). Intermediate surgeons performed significantly better than novices (P=.022), with shorter procedural times (P=.018) Three of the intermediate group achieved the proficiency level set by the expert group, with no significant difference noted between these two groups (=.06). Time taken to completion for expert surgeons was less than intermediate group, although this did not reach significance (P=.19). CONCLUSION: The proximal femoral nail module on the Precision OS platform demonstrated good face, and construct validity. Further research evaluating use of virtual platform simulation in surgical trauma training is needed.