The orthopedic surgery preparatory exam course: Measuring residents’ satisfaction and perceptions through video ethnomethodology and survey analysis

Objectives: Orthopedic training in Saudi Arabia has changed how residents are assessed for their board examination. The new format uses scenario cases instead of real patients during the assessment. However, these changes were not received well by the residents. The Orthopedic Surgery Preparatory Exam Course is a 3-day training course designed specifically to address these concerns. This study investigated the effectiveness, perceptions, and satisfaction levels of the residents who took this course, emphasizing the video recording approach. Methods: A quantitative survey was designed by the research team and validated by experts. Edits were made after their feedback. Purposive sampling was used, and all 12 attendees of the course participated. All participants were 5th-year residents enrolled in the orthopedics residency training program in Saudi Arabia. A qualitative ethnomethodology analysis of video recordings for pre- and post-mock exams was also conducted. Results: The analysis demonstrated that participants were less anxious in the post-mock exam and showed improvement in their confidence and communication skills based on analysis of the assessed criteria such as eye contact, vocal projection, gestures, posture, and movement. The participants generally perceived the course useful in preparing for their board exam. Conclusion: The participants generally perceived the course to be useful in helping them to prepare for their board exam by familiarizing them with the exam environment. The participants reported the strength of the course as being able to provide a realistic simulated experience. On the other hand, the participants viewed the weakness of the course in its duration and generally requested more days to be added to the course. They were generally satisfied with the course helping them prepare for the board exam. It is recommended to incorporate the course as part of the residency training program curriculum. </jats:sec

Congenital insensitivity to pain with anhidrosis and multiple Charcot joints in a child: A case report

Congenital insensitivity to pain with anhidrosis (CIPA) syndrome is a rare autosomal recessive condition affecting various tracts in the peripheral and autonomic nervous system. CIPA has an incidence of 1/125,000,000. The only known causative gene to date is neurotrophic tyrosine receptor kinase 1 (NTRK1), which is located on chromosome 1q21-q22. The mutation in the NTRK1 gene is associated with consanguineous marriages. Manifestations of this condition are highly variable, with insensitivity to pain being the mainstay. Patients are commonly presented with bruises, joint dislocations, multiple fractures, oral manifestations, and disfigured joints. We present a rare case of a CIPA patient manifested with Charcot’s joints. A 15-year-old male presented with multiple destructed joints in both knees, ankles, and wrists. He uses walking aids and has a loss of response to painful stimuli. The condition started at the age of 7 years. Other manifestations were fever, anhidrosis, mental retardation, and self-mutilating behaviors. The parents have a consanguineous marriage. Nerve and muscle biopsies were obtained and revealed no significant pathological abnormalities. However, imaging showed grossly disorganized joints and the clinical diagnosis of CIPA was confirmed. As illustrated in this case, the occurrence of CIPA syndrome, hereditary sensory and autonomic neuropathy Type IV, remains highly unprecedented and genetic testing is mandatory for the diagnosis. In addition, nerve and muscle biopsy should be obtained, and advanced imaging such as magnetic resonance imaging is needed to evaluate the case fully. There is no definitive therapeutic intervention for this condition, therefore, education and prevention are important to improve the quality of life of a CIPA patient.</jats:p

Surgical Site Infection Rate in Sutured Versus Stapled Wound Closure After Orthopedic Limb Surgeries: A Prospective Cohort Study

Objectives: Surgical site infection (SSI) is a demanding post-surgical complication. SSI has been linked to significant morbidity, mortality, and rising healthcare expenditure. Staples and sutures are the most utilized methods in orthopedic skin closure. The aim of this study was to compare the rate of SSI in sutured versus stapled wound closure after orthopedic limb surgeries. Methods: A prospective cohort study was conducted between September 2019 and March 2021. Patient demographics, method of wound closure, and potential risk factors associated with SSI were recorded. A multivariate logistic regression analysis was performed to identify independent risk factors associated with SSI. Results: A total of 775 patients were included. Eighteen patients (2.3%) acquired an SSI. 3.5% of the staples group and 1.1% of the suture group contracted an SSI (p = 0.028, univariate analysis). Length of hospital stay (LOS) was significantly higher in the staples group (p &lt; 0.001). Use of antibiotics (AOR 5.938; 95%CI 1.693&ndash;20.820), LOS (AOR: 1.047, 95% CI:1.013&ndash;1.083), and duration of antibiotic prophylaxis (AOR:1.076, 95% CI: 1.010&ndash;1.147) were independent risk factors of SSI. Conclusions: The use of staples was associated with longer hospital stays. Use of antibiotics, prolonged hospital stays, and extended antibiotic prophylaxis were independent risk factors for SSI. These findings suggest that the choice of closure method may impact hospital stay, which could influence SSI risk