Comparison of Instructor-Led and Video-Based Instruction in Teaching Suturing to Medical Students.

INTRODUCTION: We conducted a single-blind, prospective, randomized, 3-arm controlled trial to compare the efficacy of interactive and noninteractive video-based with instructor-led teaching in acquiring and retaining basic surgical skills. METHODS: Participants were pretested after providing written instruction using a simulator. After the pretest, students were randomized to three groups: noninteractive video-based instruction (NIVBI), instructor-led teaching with concurrent feedback, and interactive video-based instruction (IVBI). An immediate post-test and a retention test were performed 1 mo after the practice session's end to assess the efficacy of practice conditions. Two experts blinded to the experimental condition evaluated performance using expert-based assessment. Data were analyzed using SPSS. RESULTS: There were no differences in expert-based assessments between groups at the pretest. All three groups showed significant improvements in expert-based scores between the pretests and post-tests as well as between pretests and retention tests (P < 0.0001). Instructor-led teaching and IVBI were equally effective initially for teaching this skill to naive medical students and showed better performance than NIVBI (P < 0.0001 each). At retention, IVBI displayed superior performance compared to NIVBI and the instructor-led group (P < 0.0001 each). CONCLUSIONS: Our result showed that video-based instruction could be as effective as instructor-led teaching in acquiring basic surgical skills. These findings support the idea that with thoughtful incorporation into technical skill curricula, video-based instruction may efficiently use faculty time and serve as a helpful adjunct for basic surgical skills training.

Outcomes of Arthroscopic Lunate Core Decompression Versus Radial Osteotomy in Treatment of Kienböck Disease.

PURPOSE: The purpose of the study was to evaluate the functional and radiographic outcomes of arthroscopic lunate decompression versus radial osteotomy in the treatment of Kienböck disease (KD). METHODS: In a prospective cohort design, we enrolled 82 patients with KD with Lichtman stages I to IIIb. Participants assigned themselves to groups by choosing either arthroscopic lunate core decompression and synovectomy (group A; n = 54) or radial osteotomy (group B; n = 28). For radial osteotomy, a distal radius volar approach was used and a shortening osteotomy (in negative and neutral ulnar variance) or lateral closing wedge osteotomy (in positive ulnar variance) was performed. Arthroscopic lunate core decompression was performed under direct visualization from the 3-4 portal using a shaver (through the 6R portal) and a cutting burr (through the trans-4 portal). The shortened Disabilities of the Arm, Shoulder, and Hand (QuickDASH) score, visual analog scale (VAS) score for pain, wrist passive flexion/extension, grip strength, and radiographic assessments (Lichtman classification, radioscaphoid angle, carpal height ratio) were recorded before surgery and at the final follow-up. RESULTS: Sixty-four patients were included in the final analysis (44 in group A and 20 in group B). The mean ages of participants were 33 ± 11 years in group A and 31 ± 8 years in group B. The mean follow-up periods were 44 ± 20 months in group A and 37 ± 23 months in group B. The QuickDASH score, VAS score, and passive wrist movements significantly improved in both groups. Grip strength showed a significant increase in group A only. The postoperative functional analysis between the 2 groups showed no significant difference, except for the wrist passive extension, which was higher in group A. Lichtman staging remained the same in 79.5% and 73.6% of patients in groups A and B, respectively. CONCLUSIONS: An arthroscopic lunate core decompression and wrist synovectomy has comparable midterm results to radial shortening osteotomy in the treatment of KD. TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic II.

Proximal radial diaphyseal segment resection for posttraumatic proximal radioulnar synostosis: a prospective study of 15 cases.

BACKGROUND: Proximal radioulnar synostosis is a complication after elbow injuries. Various treatment methods have been reported and are associated with unpredictable outcomes. In a prospective study, we evaluated the medium-term effects of proximal radial resection on wrist and elbow function and forearm rotation in 15 cases. METHODS: We treated 15 patients with posttraumatic proximal radioulnar synostosis by resection of 1 cm of the proximal radial diaphysis. On the preoperative examination and last follow-up, the Mayo Elbow Performance Score, grip force, visual analog scale for elbow and wrist score, radiographic ulnar variance changes, and elbow range of motion were measured. The Disabilities of the Arm, Shoulder, and Hand (QuickDASH) score and the general satisfaction of the patients were assessed at the final follow-up. RESULTS: The mean duration of follow-up was 31 ± 13 months. The mean active postoperative supination/pronation arc was 101° ± 45°. The mean increase measured in the ulnar variance at the final follow-up was 3.3 ± 1.5 mm (P = .02). The mean final QuickDASH score was 13.3 ± 12.1. The preoperative and final Mayo scores were 57 ± 10 and 91 ± 7, respectively (P = .01). The general satisfaction with the results of the operation was 86.6%. CONCLUSIONS: We suggest that proximal radial resection for the treatment of posttraumatic proximal radioulnar synostosis shows acceptable results in adults regarding the recovery of range of motion and patient satisfaction. This technique might be considered as a salvage procedure, particularly in cases with previous failed heterotopic resection at the proximal radioulnar joint, resulting in disturbed anatomy. LEVEL OF EVIDENCE: Level IV, case series, treatment study.

Outcomes of the Pin and Plate Technique in Complex Fractures and Nonunions of Distal Humerus.

Objectives: This study investigates outcomes and complications of the pin and plate fixation technique, which was suggested for distal humerus fractures. It also reports the results of its application in nonunions for the first time. Methods: Forty-nine fracture and 17 nonunion cases who underwent surgery using the technique and were followed for at least 18 months were assessed through the range of motion (ROM), Quick Disabilities of the Arm, Shoulder, and Hand Score (Quick-DASH), Mayo Elbow Performance Score (MEPS), four-category verbal rating scale (VRS-4), and complications. Results: At the last follow-up, the mean scores of flexion, extension deficit, supination, and pronation ranges in fracture cases were 116.7, 22.9, 90.0, and 90.0 degrees, respectively. These values in nonunion cases were 112.2, 26.4, 86.7, and 85.5 degrees, respectively. The average ROM in fracture cases was 93.8, while it was 85.8 degrees in nonunion cases. The mean Quick-DASH in fracture and nonunion patients were 25.2 and 31.1, respectively. According to the MEPS, 77.5% of fracture and 64.7% of nonunion patients had excellent and good results. In fracture cases, the mean scores of VRS-4 at rest, light activity, and hard activity were 1.3, 1.8, and 2.3, respectively. These values in nonunion cases were 1.8, 2.2, and 2.5, respectively. The most common complications were device prominence and ulnar neuropathy. Conclusion: An acceptable union rate and proper elbow function can be expected by using this technique. Owing to the promising results of this study, further high-quality studies are recommended. Hereby this technique is called Persian Fixation.

Cell therapy efficacy and safety in treating tendon disorders: a systemic review of clinical studies.

PURPOSE: Despite substantial animal evidence, cell therapy in humans remains in its infancy. The purpose of this study was to examine the potential therapeutic effects and safety of cell therapy in the treatment of tendon disorders. METHODS: According to the PRISMA guideline, a systematic review was performed on clinical studies concerning cell therapy in tendon disorders. A comprehensive search including the 5 databases of MEDLINE, Embase, Scopus, Web of Science, and Cochrane Library until December 2021 was carried out and associated with hand searching. The quality of the eligible studies was assessed using the tools suggested by Cochrane recommendations. Qualitative synthesis was performed in 2 tables and discussed separately for rotator cuff, elbow, patella, Achilles, and gluteal tendons. RESULTS: Through 6017 records, 22 studies were included in the qualitative synthesis, including 658 patients. All the studies administered autologous cells, except one that used allogenic adipose-derived mesenchymal stem cells (Allogenic AD-MSC). Almost all studies demonstrated the safety of cell injection in their follow-up period with no serious side effects or immunologic reactions, with only a few related minor adverse events in some cases. The included studies showed the effectiveness of cell injection in tendinopathies of different sites, rotator cuff, elbow, patella, Achilles, and gluteal tendons. Among the rotator cuff studies, 4 comparative studies claimed that cell therapy is a more efficient treatment with a lower retear rate and pain level compared to the control group. However, one study found no differences between the groups. No controlled study has been performed on elbow tendinopathies, but 5 case series demonstrated the effectiveness of cell injection in elbow tendon disorders. For Achilles tendinopathies, only one randomized controlled trial (RCT) found that both cell therapy and control groups showed significant pain reduction and functional improvement with no statistical differences at the 6 months follow-up, but the cell therapy group had improved faster at earlier follow-ups. Patellar tendinopathy was studied in 2 RCTs, one did not show a significant difference and the other showed superior improvement compared to controls. CONCLUSION: Cell therapy showed promising results and the available evidence suggests that it is safe at several sites of tendon disease. Based on available evidence, cell therapy should be suggested in specific conditions at each site. To approve cell therapy for tendon diseases, randomized clinical trials are required with a large sample size and long-term follow-ups. LEVEL OF EVIDENCE: IV.

Orthopedic Trauma Surgeries in COVID-19 Pandemic; A Trauma Management Algorithm.

After the COVID-19 outbreak worldwide, we will sooner or later encounter trauma patients with COVID-19 in the developing countries. It is a challenging decision-making process for an orthopedic surgeon to provide the patients with the best practice in the crisis. Here we discuss the issue in terms of clinical severity of COVID-19 pneumonia, priority of orthopedic surgical trauma procedures and standard of care for the treatment of trauma injuries. We finally propose an algorithm for better management of trauma patients in the setting of COVID-19 mass spread.

Novel Coronavirus Infection in Orthopedic Patients ; Report of Seven Cases.

During the course of novel coronavirus pandemic ,Shariati hospital in Tehran , as a tertiary center in both orthopedic trauma and COVID-19 , we detected 7 cases with definite diagnosis of COVID-19 and concomitant emergent orthopedic problem.This paper represents considerations and special issues in managing and decision making in these patients.

Trans-4 Portal as a New Portal for Accessing the Lunate in Wrist Arthroscopy: a Cadaveric Study.

BACKGROUND: Evolving wrist arthroscopy requires creating new portals, and creating portals reciprocally leads to increased indications for arthroscopic wrist procedures. To facilitate access to the lunate bone and fossa for new arthroscopic procedures, a new portal was used. This is a cadaveric study of this portal. OBJECTIVES: In this cadaveric study, we evaluated a portal in wrist arthroscopy for procedures involving the lunate bone and lunate fossa. MATERIALS AND METHODS: Seventeen wrists from 10 fresh cadavers were included in this study. After diagnostic arthroscopy, a portal (Trans-4) was made through the fourth extensor compartment, exactly along the lunate's long axis under direct visualization from the 3-4 portal. Strand retractors were used to protect the extensor tendons and posterior capsule. Lunate bone core decompression and osteoscopy were done through the portal. At the end of the procedure, the position of the decompression hole in the lunate and any possible injury to the extensor tendons, distal radius cartilage, lunate cartilage, and perilunate ligaments were investigated. RESULTS: Lunate bone decompression was performed successfully in all cases using the trans-4 portal. In 15 wrists, the lunate hole was located in the middle third. In the other two wrists, it was located slightly radial in one case and slightly on the ulnar side in the other case. There was no cortical penetration during decompression, and no extensor tendon, superficial nerve branches, or peri-lunate ligament injuries were observed. CONCLUSIONS: The trans-4 portal could be a safe working portal in wrist arthroscopy that enables access to the lunate bone and lunate fossa.

Subarachnoid Space Transplantation of Schwann and/or Olfactory Ensheathing Cells Following Severe Spinal Cord Injury Fails to Improve Locomotor Recovery in Rats.

Treatment of spinal cord injury by exogenous cells has brought both successful and unsuccessful results. Olfactory ensheathing cells and Schwann cells have been widely used for transplantation purposes. In this study, we investigated the effects of these cells on contused spinal cord by introducing cells into subarachnoid space. Fifty thousand Schwann cells or olfactory ensheathing cells or a mixture of both cell types were transplanted one week after a 3-second clip compression injury at T-9 spinal cord level in rats. Starting from the day one of spinal cord injury, animals were assessed for six months by BBB test and then were sacrificed for immunohistochemistry labeling of the spinal cord injury site. There was no locomotor recovery in any of the treatment groups including controls. Immunohistochemistry assessment indicated positive labeling of P75 and S100 markers in the cell-transplanted groups compared with control. Our data suggest that transplantation of Schwann cells and/or olfactory ensheathing cells into the subarachnoid space does not improve motor recovery in severely injured spinal cord, at least with the number of cells transplanted here. This, however, should not be regarded as an essentially negative outcome, and further studies which consider higher densities of cells are required.

Descriptive epidemiology of traumatic injuries in 18890 adults: a 5-year-study in a tertiary trauma center in iran.

BACKGROUND: Basic epidemiological data can provide estimates when discussing disease burden and in the planning and provision of healthcare strategies. There is little quantitative information in the literature regarding prevalence of traumatic injuries from developing countries. OBJECTIVES: The aim of the current preliminary study was to reveal the prevalence and age and gender distribution of various traumatic injuries in a tertiary referral orthopedic hospital in Iran. PATIENTS AND METHODS: In a prospective descriptive study, all traumatic injured patients attending the Orthopedic Trauma Unit of our center in a five year period were included. Demographic details, the cause of injury, injury classification and treatment were recorded. For each of the five-year age groups and each gender we calculated the numbers with fractures, dislocations, soft tissue injuries, ligamentous injuries and lacerations and derived average age and gender-specific prevalence as well as seasonal variations. RESULTS: A total of 18890 adults were admitted, 13870 (73.4%) males and 5020 (26.6%) females. There were 8204 (43.4%) fractures. The male fracture age distribution curve was unimodal and there was a detectable bimodal pattern in females. Under 65 years males are 3 times more likely to sustain a fracture than females which decreases to equal risk over the age of 65. The most common fracture site was distal radius/ulna (13.8%), followed by tibial diaphysis (8.8%), proximal femur (7.8%), finger phalanges (6.4%), metacarpals (6%) and metatarsals (5.9%). There were seasonal variations in fracture incidence with peaks in February, March and October. The least number of fractures occurred in June. CONCLUSIONS: The risk of traumatic injuries is higher among specific age groups with different patterns emerging for men and women. Thus, the descriptive epidemiology will provide useful information for treatment or injury prevention strategies, resource allocation, and training priorities.