RESUMEN
Introduction During the COVID-19 pandemic, the AO Foundation, an orthopedic education organization, had to transition its live education programs to an online format. Skills that were previously evaluated and corrected in person by educators were now assessed through online lectures and discussion groups. Our goal was to evaluate an online course designed to teach the skill of "leg length and coronal deformity measurement" and to assess participants' ability to demonstrate this skill using online software. Methods An IRB-approved study was conducted during an online osteotomy course. A total of 176 participants were instructed on how to measure length and angulation through the course lectures and planning tutorials. The Bonesetter App (Detroit Bonesetter, Detroit, Michigan, USA) was used as the digital planning tool. Participants analyzed four cases of coronal deformity using long-leg standing radiographs. They were required to identify any deformities present, specify the type of deformity, and determine whether it affected the femur, tibia, or joint. Additionally, participants needed to calculate the deformity as part of the osteotomy planning process. Their measurements and drawings were saved and subsequently evaluated by two independent observers. Results Out of 176 online participants, 76% (315 out of 417) correctly completed the four exercises. The most frequent errors occurred in measuring total deformity and joint deformity. The average standard deviation of length measurements was ±0.29 cm (based on 244 measurements), while for angular measurements, it was ±0.71 degrees (based on 688 measurements). The intraclass correlation coefficient was greater than 0.96. Conclusions The online course effectively taught coronal deformity measurement, although participants struggled most with measuring joint angles and total deformity. Future courses should provide more detailed explanations for these measurements.
RESUMEN
Background and objectives: Alignment of the lower extremity is important when treating congenital deformities, fractures, and joint replacement. During the COVID-19 pandemic, AO North America offered an online course on deformity measurement and planning. The Bonesetter app is a deformity planning tool that is freely available online. The purpose of this study was to see how effective an online course was in teaching axial alignment measurement and to assess that skill using an online digital planning tool, the Bonesetter app. Materials and Methods: An online module on axial alignment was provided during the AONA osteotomy course as well as a tutorial on how to use an online digital planning tool (Bonesetter app). The tools within the Bonesetter app allow users to draw digital lines directly on the CT images and measure the exact angle between two planes. Participants in this study were directed to perform these measurements in four different cases that tested different variations of deformity. Results: The measurements were completed correctly in case 1 = 56%, case 2 = 61%, case 3 = 84%, and case 4 = 76%. The standard deviation of angular digital measurements between individuals was ±4.26 degrees. Measuring the angle directly vs. drawing angles to a horizontal line had smaller standard deviations per case (p < 0.005) and less incidents outside 1 standard deviation for each measurement. Errors in adding and subtracting were the most common errors, particularly in relation to femoral anteversion or retroversion. Conclusions: The online course successfully instructed a group of orthopedic surgeons to measure alignment and malalignment of lower limb axial deformities. The Bonesetter app helped participants to learn this skill and identify errors in measurement. The inability to differentiate between anteversion and retroversion of the femur is a common source of error when it occurs and should be a focus of instruction.