Background: High cost and ethical controversy of using living models in microsurgical training made non-living models more popular. However, non-living models don’t provide appropriate feedback of microsurgical performance. Currently existing Global Rating Scales used for advanced microsurgical skills validation are difficult to apply on non-living model. This study presents a simple instrument for basic assessment of microsurgical anastomosis on non-living model. Methods: Seventy medical students were divided into 2 groups depending on their prior microsurgical experience. Each participant performed 3 end-to-end anastomoses on chicken femoral artery model. Anastomoses were reviewed by 3 blinded experts and then photographed. Evaluation included a patency tests, longitudinal cut of anastomosis, and the newly proposed tool 10 Point Microsurgical Anastomosis Rating Scale (MARS10). Presented scale consists of 5 factors important for anastomosis closure (anastomosis closure, suture spacing, bites size, knot tying, and cut ends length), graded on 3 point scale (0-2 points). Results were analyzed with analysis of variance, Spearman correlation, and t Student test. Results: Anastomoses evaluated by experts as patent significantly correlated with a high summary score in MARS10 scale (r = 0.73 P < .0001). There was a significant difference in MARS10 score between groups (P < .0001). There were no significant inter-rater differences in scoring among all 3 evaluators (p > .05). Conclusions: 10 Point Microsurgical Anastomosis Rating Scale is a quick, valid, and reliable tool to assess microsurgical end-to-end arterial anastomoses on non-living model.

Background Repetitive training is essential for microsurgical performance. This study aimed to compare the improvement in basic microsurgical skills using two learning methods: stationary microsurgical course with tutor supervision and self-learning based on digital instructional materials. We hypothesized that video-based training provides noninferior improvement in basic microsurgical skills. Methods In this prospective study, 80 participants with no prior microsurgical experience were randomly divided into two groups: the control group, trained under the supervision of a microsurgical tutor, and the intervention group, where knowledge was based on commonly available online instructional videos without tutor supervision. Three blinded expert microsurgeons evaluated the improvement in basic microsurgical skills in both groups. The evaluation included an end-to-end anastomosis test using the Ten-Point Microsurgical Anastomosis Rating Scale (MARS10) and a six-stitch test on a latex glove. Statistically significant differences between groups were identified using standard noninferiority analysis, chi-square, and t-tests. Results Seventy-seven participants completed the course. Baseline test scores did not differ significantly between groups. After the 4-day microsurgical course, both groups showed statistically significant improvement in microsurgical skills measured using the MARS10. The performed tests showed that data for self-learning using digital resources provides noninferior data for course with surpervision on the initial stage of microsurgical training (7.84; standard deviation [SD], 1.92; 95% confidence interval [CI], 7.25–8.44) to (7.72; SD, 2.09; 95% CI, 7.07–8.36). Conclusion Video-based microsurgical training on its initial step provides noninferior improvement in microsurgical skills to training with a dedicated instructor.

A comminuted distal radial fracture is sometimes so fragmented that it is impossible to treat it with fixation using a plate and screws. In this case, we can perform a bridging fracture and joints with an external fixator or a dorsal spanning plate. Unfortunately, both methods completely immobilize the wrist until the implants are removed. In the article is presented an alternative method of bridge fixation. After fracture bridging with a volar spanning plate, the patient immediately has the possibility of dorsal and volar flexion of approximately 30 degrees in each direction. The study group consists of 6 patients treated surgically with a volar spanning plate after an unsuccessful attempt of stable fixation with a volar plate. 5 patients suffered from a distal radius fracture in the AO classification type C3, and one man with an inveterate dorsal dislocation of the wrist and fracture of the radial styloid process type B1. The volar spanning plate was fixed distally in the scaphoid and lunar, and proximally in the shaft of the radius. All patients achieved bone union. There was no destabilization or any damage of the implant. The average dorsal flexion was 48°, and the palmar flexion was 45°. All patients obtained a satisfactory result according to the Mayo scale, without pain. The volar spanning plate may be indicated when intraoperative fixation by a volar plate turns out to be too optimistic. Compared to the external fixator or the dorsal spanning plate, the volar spanning plate does not distract the midcarpal and carpometacarpal joints. What is more, immediately after the operation, the possibility of dorsal and palmar flexion are approximately 30 degrees in each direction, which improves the quality of life in the first weeks of treatment. After removing the implant, there is still a chance to improve the range of motion of the wrist.

Introduction: Displaced proximal humerus fractures pose significant clinical problems. The aim of this study was to compare treatment results between open reduction and internal fixation (ORIF) and hemiarthroplasty (HA). Material and methods: The study was a retrospective assessment. Sixtythree patients (30 HA, 33 ORIF) met the inclusion criteria; mean age: 64.5 years. The Constant-Murley scale, DASH score and VAS surveys for pain and satisfaction were used to evaluate the results. Results: The HA group: the constant score was 44 points, and the DASH score was 57 points; 53% of patients had osteolysis of the greater tubercle; none of the patients had revision surgery. ORIF group: the constant score was59 points, and the DASH score was 38 points; 21% of patients had a vascular necrosis; revision surgery was performed in 18% of cases. A significant correlation between good functional outcomes and young age of patients was found in the ORIF group (p-value < 0.048). Patients who started physical therapy earlier achieved better results. DASH scores were better compared to ones from the objective Constant-Murley score. There was no difference in satisfaction between HA and ORIF groups (p-value < 0.1). Conclusions: The ORIF should be considered for patients < 60 years old, but gives increased risk of urgent revision, due to screw protrusion. The HA provides fewer complications, lower risk of revision and can be better for patients between 60 and 70 years old. When choosing the treatment method, we should avoid focusing only on fracture configuration, but should also consider patient-related factors, such as age and lifestyle.

Introduction. Distal radius fractures are one of the most common bone injuries. Modern treatment methods are needed not only to reduce the time needed to heal, but also allow the wrist the full range of motion as soon as possible. The solution should provide stable bone fixation with the least possible damage to soft tissues, which will allow quick recovery of extremity function. The method meeting these criteria is intramedullary fixation. Aim of the study. To evaluate the treatment results of distal radius fractures with the DRONes® hybrid nail plate. Material and methods. The study group consists of patients with distal radius fracture treated with open reduction and intramedullary fixation. Patients aged 24 to 69 years (average 54 years) were operated on after a failed attempt to adjust the fracture using the closed reduction method. 40 distal fractures of the distal radius qualified for the following 5 types according to AO: 2 fractures -A2, 5 -A3, 8 -C1, 14 -C2, 11 -C3. Two weeks after the surgery, X-rays were performed to check the position of the bone fragments and implant. After a further 6-7 weeks, the union and wrist function were evaluated. Results. Bone union was achieved in all patients within 8-9 weeks, and the range of wrist mobility was only slightly limited. The most common complication was the neurapraxia of the superficial branch of the radial nerve disappearing after 6-8 weeks. Conclusions. Patients treated with the DRONes® hybrid nail plate achieve good functional results after 8-9 weeks and can return to work and their preinjury lifestyle. An additional advantage is the simple surgical technique.