ABSTRACT
Objective:To investigate the outcomes of the surgical treatment of fracture of the first metatarsal base with plantar plate via the first metatarsal medial approach.Methods:A retrospective study was conducted of the 12 patients who had been treated for fracture of the first metatarsal base from January 2016 to December 2018 at Department of Trauma Orthopaedics, Renji Hospital. They were 8 men and 4 women, with an average age of 39.6 years (from 27 to 54 years). The fracture affected the left foot in 5 cases and the right foot in 7. Their fracture of the first metatarsal base and tarsometatarsal joint instability were fixated by plantar plate via the first metatarsal medial approach, and reduction and fixation was also conducted via a dorsal incision when other metatarsotarsal joint injuries were combined. Postoperative X-ray follow-ups were performed regularly. The American Orthopedic Foot and Ankle Society (AOFAS) midfoot scores, visual analogue scale (VAS) pain scores and complications were recorded at the final follow-up.Results:All the patients were followed up for 12 to 19 months (mean, 15.1 months). Primary incision healing was observed in all the 12 patients. No complications like skin necrosis, infection or neurovascular lesion occurred. Fracture union was achieved in all the 12 patients after 12 to 14 weeks (average, 12.6 weeks). At the final follow-up, all the patients could walk with full weight-bearing, the plantar flexion and dorsiflexion of the ankle and the muscle strengths of varus and valgus were normal, and the X-ray film showed that reduction of the tarsometatarsal joint was not lost. At the final follow-up, the AOFAS midoot scores ranged from 82 to 96 (mean, 88.9) and the VAS scores from 0 to 3 (mean, 1.2).Conclusion:Plantar plate fixation via the first metatarsal medial approach can result in satisfactory outcomes for fractures of the first metatarsal base, especially for those with a major fracture fragment at the metatarsal planter side.
ABSTRACT
Objective To evaluate the application of scenario-based training and medical simulator in the orthopedics education. Methods A total of 60 students from Shanghai Jiao Tong University School of Medicine who finished their orthopedics internship from January 2016 to July 2016 were involved. They were randomly divided into the study group and control group with 30 students each. The study group re-ceived 2 classes of scenario-based training and medical simulator assisted education during their internship in the orthopedics department while the control group received 2 classes of traditional lessons instead. Sur-veys were conducted after the internship and the scores of internship were also recorded. Result The overall satisfaction was higher in the study group than the control group [(8.6±0.6) vs. (8.1±0.5), P=0.001]. On the part of learning interest, clinical thinking, clinical practice and group working, the study group also received better evaluation (P<0.05). The study group achieved better scores in the final examination than the control group [(84.4±2.6) vs. (82.5±3.4), P=0.018]. Conclusion The combination of scenario-based training and medical simulator can improve the ability of medical students in the orthopedics education, and receive higher satisfaction.