Interlocking Fixation in Fassier-Duval Rods: Performance and Success Factors.

INTRODUCTION: Pediatric patients with osteogenesis imperfecta (OI) can be treated with intramedullary Fassier-Duval rod (FDR) systems for limb deformity or recurrent fractures. Single-interlocking pins can improve epiphyseal fixation, but there is a paucity of literature examining incidence of rod migration or pin backout long-term. The purpose of this study is to quantify rates of rod migration and pin backout in OI patients treated with single-interlocking FDRs. METHODS: A retrospective chart review was performed on pediatric patients treated at a tertiary care center across a 15-year period. Inclusion criteria to select patients was: (1) Pediatric patients (below 18 y of age); (2) Patients with confirmed OI; and (3) Patients with lower extremity fractures or deformity treated with FDRs with distal interlocking pins. Age at time of surgery, rates of obturator migration and pin backout and prominence were collected. We recorded if pin tips were bent by the surgeon during the procedure. Bivariate statistics were used to analyze risk factors for pin backout and prominence. RESULTS: Twenty-four single-interlocking pin FDRs (21 tibia, 3 femur) were identified. The mean age at index surgery was 5.7±3.4 years, with the mean follow-up time of 7.2±4.7 years. Fourteen (58%) rods underwent revision surgery. Obturator proximal migration was observed in 3/24 rods (13%). No cases of obturator distal migration were observed (0/24, 0%). Mean proximal obturator migration was 2.16±1.8 cm. Revision for pin backout was observed in 10 (42%) rods and pin prominence in 11 (46%) extremities. Bending interlocking pins on at least 1 end was associated with decreased pin backout (P=0.01) and prominence (P=0.04). CONCLUSIONS: Even with distal interlocking pins, the obturator of FDRs can still migrate over time. Pin backout is a common indication for revision surgery. Bending interlocking pins can decrease rates of pin backout and prominence. LEVEL OF EVIDENCE: Level III.

Evaluation of a Slipped Capital Femoral Epiphysis Virtual Reality Surgical Simulation for the Orthopaedic Trainee.

OBJECTIVE: The purpose of this study was to compare outcomes between orthopaedic trainees using various preoperative training platforms (physical simulation [PS], virtual reality [VR], and reading/videos) in a slipped capital femoral epiphysis model. METHODS: Participants were randomly assigned to one of the three groups: (1) reading/video control group (n = 7), (2) VR group (n = 7), or (3) PS group (n = 7). Participants in the VR group completed a VR slipped capital femoral epiphysis module while participants in the PS group practiced the placement of a screw in the physical module before evaluation of percutaneous screw placement in the PS model. Outcomes evaluated included overall surgical time, amount of fluoroscopy, Global Rating Scale score, radiographic screw position, physical screw accuracy, presence of breeching of the articular surface or femoral neck, and overall platform rating (0 to 10). RESULTS: No difference was observed in surgical time, Global Rating Scale score, radiographic or physical accuracy of screw position, or articular surface breaching between the groups. Subjectively, there was a difference in utility of platform rating between the groups (PS: 10 ± 0, VR: 7 ± 2, and control: 6 ± 1, P = 0.001). CONCLUSION: Training with VR was subjectively rated higher in value compared with reading/video methods and had similar performance outcomes compared with training with PS.

Association of Disposable Perioperative Jackets With Surgical Site Infections in a Large Multicenter Health Care Organization.

Importance: To help prevent surgical site infections (SSIs), recommendations by a national organization led to implementation of a mandatory operating room policy in a large multicenter health care organization of required use of disposable perioperative jackets. Objective: To assess whether the use of perioperative disposable jackets is associated with the incidence of SSIs. Design, Setting, and Participants: Surgical site infection data for patients undergoing clean surgical procedures were retrospectively reviewed from 12 hospitals in a large multicenter health care organization during a 55-month period from January 1, 2014, to July 31, 2018. The incidence of SSI was analyzed for all National Healthcare Safety Network monitored and reported procedures. The patient population was split into 2 groups; the preintervention group consisted of 29 098 patients within the 26 months before the policy starting March 1, 2016, and the postintervention group consisted of 30 911 patients within 26 months after the policy. Main Outcome and Measures: Comparison of the incidence of SSIs before and after intervention periods underwent statistical analysis. The total number of disposable jackets purchased and total expenditures were also calculated. Exposures: Implementation of the mandated perioperative attire policy. Results: A total of 60 009 patients (mean [SD] age, 62.8 [13.9] years; 32 139 [53.6%] male) were included in the study. The overall SSI incidence for clean wounds was 0.87% before policy implementation and 0.83% after policy implementation, which was not found to be significant (odds ratio [OR], 0.96; 95% CI, 0.80-1.14; P = .61). After accounting for possible confounding variables, a multivariable analysis demonstrated no significant reduction in SSIs (OR, 0.85; 95% CI, 0.71-1.01; P = .07). During the postintervention study period (26 months), a total of 2 010 040 jackets were purchased, which amounted to a cost of $1 709 898.46. Conclusions and Relevance: The results of this study suggest that the use of perioperative disposable jackets is not associated with reductions in SSI for clean wounds in a large multicenter health care organization and presents a fiscal burden.