Validation of navigation assisted cup placement in total hip arthroplasty.

PURPOSE: Computer navigation has the potential to provide precise intraoperative knowledge to the surgeon. Previous studies with navigation have confirmed its function for improved component position but few studies have reported the accuracy and precision of navigation system in clinical use. With this study we propose to evaluate the efficacy of navigation in guiding cup placement. METHODS: Fifty-six patients undergoing primary total hip arthroplasty were prospectively included in this study. Stryker imageless navigation system which is accurate to 0.5° was used in all cases. Intraoperative data was collected for the acetabular component position using navigation for the freehand cup placement and the final cup placement done using navigation. Postoperative evaluation of component position was done with computed tomography (CT) and the deviation from intraoperative freehand and navigation values were calculated. RESULTS: The mean inclination of the freehand reading was 39.5° (range, 20°-58°), mean version of freehand reading was 10.7° (-6°- 27°), and the mean navigation reading was 43.2° (37°-49°) for inclination and 13.0° (-8° - 24°) for version. On postoperative CT scan analysis the mean inclination was 45.3° (34°-56°) and mean version was 15.1° (4°-25°). The deviation of the freehand inclination from the post operative CT scan reading was 11.4° (1°-30°) and the version deviated by a mean of 10.8° (2°-26°). The deviation of the navigation reading from the CT scan reading had a mean of 5.3° (1°-13°) for inclination and 5.6° (1°-17°) for version. CONCLUSION: The accuracy of the navigation system over conventional freehand cup placement is validated by this study.

Locking distal radius plate--early results from India.

BACKGROUND: Restoration of wrist function to close to preinjury levels of patients with intra-articular distal end radius fractures is of concern. Open reduction and internal fixation with angular stable screw fixation implants is coming in vogue but little literature evidence supports it. The objectives of this study are to assess the ability of volar locking plates to maintain fracture reduction when used to treat dorsally displaced intra-articular distal radial fractures and to assess the patient-related outcome after this procedure. METHODS: In a prospective study from March 2008 to September 2009, 23 cases of intra-articular distal radius fractures were included in the study. All these fractures underwent open reduction and internal fixation with 2.4 volar locking distal radius plates. Every patient was reviewed with a minimum follow-up of 36 weeks (9 months to 2 years). Radiographs were taken to assess fracture union or for any potential loss of fracture reduction. Functional outcome was assessed with evaluation of range of movements of the wrist and pain as per the Visual Analog Scale. RESULTS: Radiologic union was noted by the end of 18 weeks in 3 subjects, at the end of 24 weeks in 13 subjects and by 30th week in 6 patients. As for overall functional outcome, 4 patients had excellent outcome, 18 had good outcome, and 1 patient had poor outcome. None of our patients had neurovascular injuries or tendon ruptures during this period. CONCLUSION: Volar locking plate is a viable option for treating intra-articular distal radius fractures.

Emergency medicine crisis resource management (EMCRM): pilot study of a simulation-based crisis management course for emergency medicine.

OBJECTIVES: To determine participant perceptions of Emergency Medicine Crisis Resource Management (EMCRM), a simulation-based crisis management course for emergency medicine. METHODS: EMCRM was created using Anesthesia Crisis Resource Management (ACRM) as a template. Thirteen residents participated in one of three pilot courses of EMCRM; following a didactic session on principles of human error and crisis management, the residents participated in simulated emergency department crisis scenarios and instructor-facilitated debriefing. The crisis simulations involved a computer-enhanced mannequin simulator and standardized patients. After finishing the course, study subjects completed a horizontal numerical scale survey (1 = worst rating to 5 = best rating) of their perceptions of EMCRM. Descriptive statistics were calculated to evaluate the data. RESULTS: The study subjects found EMCRM to be enjoyable (4.9 +/- 0.3) (mean +/- SD) and reported that the knowledge gained from the course would be helpful in their practices (4.5 +/- 0.6). The subjects believed that the simulation environment prompted realistic responses (4.6 +/- 0.8) and that the scenarios were highly believable (4.8 +/- 0.4). The participants reported that EMCRM was best suited for residents (4.9 +/- 0.3) but could also benefit students and attending physicians. The subjects believed that the course should be repeated every 8.2 +/- 3.3 months. CONCLUSIONS: The EMCRM participants rated the course very favorably and believed that the knowledge gained would be beneficial in their practices. The extremely positive response to EMCRM found in this pilot study suggests that this training modality may be valuable in training emergency medicine residents.