Simulation Training of Orthopaedic Residents for Distal Radius Fracture Reductions Improves Radiographic Outcomes

Abstract

Background: Most distal radius fractures can be treated with closed reduction and casting in pediatric patients. These skills are traditionally developed treating real patients, however, there is growing interest in the use of simulation training to supplement traditional learning strategies. Methods: Seventy-eight children with distal radius fractures that underwent closed reduction and casting by novice orthopaedic surgery residents were retrospectively reviewed. Radiographic measures of patients treated by simulation-trained residents were compared with patients treated by residents without simulation training. Results: Patients treated by simulation-trained residents had less residual angulation in the anteroposterior radiograph (3.7 vs. 6.3 degrees, P=0.006) and translation on the lateral (14% vs. 21%, P=0.040) and anteroposterior radiograph (10% vs. 16%, P=0.029). Patients treated by simulation-trained residents also had lower rates of redisplacement (50% vs. 79%, P=0.016). Conclusions: Loss of reduction is common, particularly when novice trainees perform their first independent reductions. Residents who underwent simulation training had lower rates of loss of reduction, thus simulation training has potential as a supplement to the traditional apprentice model of medical education. Level of Evidence: Level III.

Ponseti Clubfoot Casting: Factors That Affect Trainee Competency (Retrospective Observational Study)

“…8,19,21,23,25,39,40 Previous research at IPOS has demonstrated that a similar cohort of TG trainees improved knowledge and skill acquisition when exposed to a septic hip virtual simulator. 25 Jackson et al 27 found that trainees exposed to a distal radius simulation model first performed better regarding casting and closed reduction of distal radius in the emergency department compared with a cohort who had no experience with simulation. Our study is different in that we did not prospectively compare two cohorts of clubfoot trainees (one with simulation exposure and one without).…”

“…8,[10][11][12][13][14][15][16][17][18][19][20] Although surgical simulation/training opportunities relevant to pediatric orthopaedic procedures have demonstrated great promise and utility, more investigation is needed to identify duration and quality of knowledge and skill transfer. [21][22][23][24][25][26][27] Pediatric clubfoot or congenital talipes equinovarus (CTEV) is one of the most common birth deformities. 28 The three-dimensional pathoanatomy of a CTEV foot is complex and the sequential casting developed by Professor Ponseti requires hands on practice and repetition.…”

“…8,10-20 Although surgical simulation/training opportunities relevant to pediatric orthopaedic procedures have demonstrated great promise and utility, more investigation is needed to identify duration and quality of knowledge and skill transfer. 21-27…”

A Single Education Session of Orthopaedic Residents Does Not Reduce The Rate of Failed Nonoperative Management or Improve Radiographic Outcomes in Pediatric Distal Radius Fractures

“… 25 - 27 Simulation modules have been developed that aim to increase resident exposure and allow for objective feedback and repetition. The impact of simulation modules on patient outcomes have been examined by Bae et al and Jackson et al 16 , 22 Both studies had a lecture on cast technique and used a simulation module incorporated into their curriculum with 2.5 to 3 hours of additional training with feedback by senior orthopaedic faculty. Both investigated the impact on different patient outcomes.…”

“…However, residents who underwent a simulation training module had a lower rate of subsequent loss of reduction, highlighting the value of a simulation module as a supplement to traditional training methods. 22 …”