Transfer Validity of Pediatric Supracondylar Humeral Fracture Pin Placement Practice on In-Theater Performance by Orthopedic Trainees Using an Augmented Reality Simulator: Protocol for a Pilot Interventional Cohort Study With a Retrospective Comparator Cohort.

BACKGROUND: Supracondylar humeral fractures (SCHF) are a common cause of orthopedic morbidity in pediatric populations across the world. The treatment of this fracture is likely one of the first procedures involving x-ray-guided wire insertion that trainee orthopedic surgeons will encounter in their career. Traditional surgical training methods of "see one, do one, teach one" are reliant on the presence of real-world cases and must be conducted within an operative environment. We have developed an augmented reality simulator that allows trainees to practice this procedure in a radiation-free environment at no extra risk to patients. OBJECTIVE: This study aims to examine whether training on a simulator in addition to traditional surgical training improves the in-theater performance of trainees. METHODS: This multicenter, interventional cohort study will involve orthopedic trainees from New Zealand in their first year of advanced training between 2019 and 2023. Advanced trainees with no simulator exposure who were in their first year in 2019-2021 will form the comparator cohort, while those in the years 2022-2023 will receive additional regular simulator training as the intervention cohort. The comparator cohort's performance in pediatric SCHF surgery will be retrospectively audited using routinely collected operative outcomes and parameters over a 6-month period. Data on the performance of the intervention cohorts will be collected in the same way over a comparable period. The data collected for both groups will be used to determine whether additional training with an augmented reality training shows improved real-world surgical outcomes compared to traditional surgical training. RESULTS: As of February 2022, a total of 8 retrospective comparator trainees have been recruited by email. The study is financially supported through an external grant from the Wishbone Orthopaedic Research Foundation of New Zealand (September 2021) and an internal research grant from the University of Otago (July 2021). CONCLUSIONS: This protocol has been approved by the University of Otago Health Ethics committee (reference HD21/087), and the study is due for completion in 2024. This protocol may assist other researchers conducting similar studies in the field. TRIAL REGISTRATION: Australian New Zealand Clinical Trials Registry ACTRN12623000816651; https://tinyurl.com/mtdkecwb. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/38282.

A comparison of embalming fluids for use in surgical workshops.

There is a growing need to learn surgical skills without risk to patients. One of the major determining factors on the suitability of specimens for surgical workshops is the fluid used for embalming. This study sought to compare three different arterial embalming preparations to a single fresh cadaver. Eleven cadavers embalmed using Graz (single cadaver), Dodge (four cadavers) and Genelyn (five cadavers) preparations were compared using four criteria; joint flexibility measured with a goniometer, tissue pliability rated on standardized videos of instrument handling, tissue color analyzed on standardized photographs and resistance to fungal growth identified by inoculation and observation of tissue blocks. The cadaver embalmed according to the Graz method had joint flexibility comparable to fresh tissue while the Dodge and Genelyn cadavers were less flexible. Tissue pliability was significantly affected by the Dodge and Genelyn methods while the Graz method tissue remained most like fresh tissue. The Graz method cadaver had color that was most akin to fresh tissue and the Dodge method cadavers were relatively more like fresh than the Genelyn. The Dodge and Genelyn method had quite similar fungicidal properties (3/11 Dodge and 2/9 Genelyn embalmed cadavers susceptible) while the Graz method cadaver did not grow mould. Variation exists between cadavers; however, the Graz method produced a cadaver with more flexible joints, better tissue quality and muscle color closest to the fresh specimen. The Dodge and Genelyn methods are similar with the exception of tissue color where the Dodge method was more similar to fresh tissue.

Anatomical variations of the common carotid artery bifurcation.

BACKGROUND: The correlation of the common carotid artery (CCA) bifurcation and its surrounding structures is poorly described. The aim of this study was to describe the anatomy of the CCA bifurcation relative to its surrounding structures. METHOD: We dissected a total of 67 carotid specimens from 36 embalmed cadavers. CCA bifurcation occurred at the superior border of thyroid cartilage in 39% and at the body of hyoid bone in 40% of specimens. RESULTS: The superior thyroid artery arose more commonly from the CCA (52.3%) than the external carotid artery (46.2%). The vagus nerve was posterior to the carotid bifurcation in 40 (60%), posterior-lateral in 24 (36%), posterior-medial in 2 (3%) and anterior-lateral in 1 specimen (1.5%). The hypoglossal nerve was closer to the CCA bifurcation when the CCA bifurcated at the level of the hyoid bone than when it bifurcated at the superior border of the thyroid cartilage (P < 0.05). The correlation of the common facial vein and the carotid artery was highly variable. CONCLUSION: The presence of a high CCA bifurcation should caution surgeons that the hypoglossal nerve lies in closer proximity and is more vulnerable. Preoperatively documenting the level of the CCA bifurcation may be helpful in identifying those patients at increased risk of iatrogenic injury.

Surgical inclination in senior medical students from the University of Auckland: results of the 2005 Senior Students Survey.

AIMS: To determine the proportion of senior medical students who are surgically inclined and to assess whether gender differences exist in surgical inclination. STUDY DESIGN: Cross-sectional survey. Twenty-five point questionnaire. Likert scale response ranking. SETTING: University of Auckland Medical School, New Zealand. PARTICIPANTS: 218 surveys were emailed to functioning addresses of fourth and fifth year students.156 students emailed responses (71.60% response rate). RESULTS: Twenty percent of students were found to be surgically inclined (95% CI 0.15-0.26). The proportion of surgically inclined males was significantly higher than females (p<0.01). A greater proportion of surgically inclined students found time spent in the operating theatre educationally valuable than non-surgically inclined students (p<0.01). No difference exists in the number of different procedures undertaken by students (p<0.05). CONCLUSION: Males are significantly more likely to be surgically inclined than females at the University of Auckland Medical School.

Surgical inclination and anatomy teaching at the University of Auckland.

BACKGROUND: Medical graduate interest in surgery has declined and medical students are less capable in anatomy than they once were. Declining interest in surgery is because of factors, including growing number of women entering medical school. There has been less emphasis in teaching anatomy at various medical schools in recent years. The aim of this study is to quantify surgical inclination in Auckland medical students to assess whether gender differences exist in surgical inclination and determine confidence in anatomy knowledge and resources used by Auckland medical students. METHOD: Survey design was cross-sectional and included 25-point questionnaire using Likert scale response ranking and tick box replies. Two hundred and eighteen surveys were emailed to functioning addresses of fourth and fifth year students at University of Auckland, School of Medicine, New Zealand. RESULTS: Response rate was 71.6%. Twenty per cent of students were found to be surgically inclined (95% confidence interval, 0.15-0.26). The proportion of surgically inclined men was significantly higher than women (P < 0.05). Thirty-three per cent of all respondents (95% confidence interval, 0.26-0.41) felt their knowledge of anatomy was adequate to practice medicine safely. Textbooks and atlases were most commonly used to learn anatomy (P < 0.05). Radiology was the least commonly used method to learn anatomy (P < 0.05). Eighty-seven per cent (95% confidence interval, 0.81-0.92) of respondents agreed that revisiting dissection during surgical attachments would be helpful. CONCLUSION: Men are significantly more likely to be surgically inclined than women at the University of Auckland. A significantly greater proportion of students felt that their knowledge of gross anatomy was inadequate for safe medical practice. Students use traditional methods to learn anatomy more commonly than radiological methods. The majority of students surveyed would like to revisit cadaver dissection during clinical attachments in surgery.