Arthroscopic simulation using a knee model can be used to train speed and gaze strategies in knee arthroscopy

Purpose This study aimed to determine the effect of a simulation course on gaze fixation strategies of participants performing arthroscopy. Methods Participants (n = 16) were recruited from two one-day simulation-based knee arthroscopy courses, and were asked to undergo a task before and after the course, which involved identifying a series of arthroscopic landmarks. The gaze fixation of the participants was recorded with a wearable eye-tracking system. The time taken to complete the task and proportion of time participants spent with their gaze fixated on the arthroscopic stack, the knee model, and away from the stack or knee model were recorded. Results Participants demonstrated a statistically decreased completion time in their second attempt compared to the first attempt (P = 0.001). In their second attempt, they also demonstrated improved gaze fixation strategies, with a significantly increased amount (P = 0.008) and proportion of time (P = 0.003) spent fixated on the screen vs. knee model. Conclusion Simulation improved arthroscopic skills in orthopaedic surgeons, specifically by improving their gaze control strategies and decreasing the amount of time taken to identify and mark landmarks in an arthroscopic task

Open versus Single- or Dual-Portal Endoscopic Carpal Tunnel Release: A Meta-Analysis of Randomized Controlled Trials

Background: Compared to the traditional open carpal tunnel release (OCTR), the additional safety and efficacy benefits of endoscopic carpal tunnel release (ECTR) remains unclear. The aim of this study is to evaluate the outcomes of ECTR versus conventional OCTR as well as determine if a difference exists between the 2 most common endoscopic techniques: the single-portal and the dual-portal endoscopic technique. Methods: We conducted a systematic literature search of Medline, Embase, PubMed, and the CENTRAL. Additional articles were identified by handsearching reference lists. We included all randomized controlled trials that compared outcomes of ECTR with OCTR technique. Outcomes assessed included length of surgery, patient reported symptom and functional measures, time to return to work, and complications. A sub-group analysis was performed to indirectly compare single- versus dual-portal endoscopic approaches. Statistical analysis was performed via a random-effects model using Review Manager 5 Software. Results: A meta-analysis of 23 studies revealed a significantly higher incidence of transient postoperative nerve injury with ECTR, regardless of the number of portals, as compared with OCTR, although overall complication and re-operation rates were equivalent. Scar tenderness was significantly diminished with dual-portal endoscopic release when compared to single-portal and open methods. The rates of pillar pain, symptom relief, and patient reported satisfaction did not differ significantly between treatment groups. Conclusions: Although endoscopic surgery may be appealing in terms of reduced postoperative morbidity and a faster return to work for patients, surgeons should be mindful of the associated learning curve and higher incidence of transient nerve injury. Further study is required to identify if an advantage exists between different endoscopic techniques.No Full Tex

Intramedullary Compression Screw Fixation of Proximal Phalangeal Fractures: A Systematic Literature Review

Proximal phalangeal fractures have traditionally been fixed via either Kirschner wires or dorsal plating. Concerns regarding lack of compression and potential for infection with wire fixation, and adhesion formation and stiffness with plating, have lead to alternative fixation methods, such as intramedullary screw fixation. However, the literature regarding this modality is limited. Methods: A systematic review was performed to review the literature regarding intramedullary screw fixation for proximal phalangeal fractures. English language studies that reported original data and commented on at least one postoperative measure of function were eligible for inclusion. 4 studies were eligible for inclusion, with a further 3 studies assessing proximal and middle phalanges analysed separately. Total active motion was greater than 240° in all proximal phalangeal studies; mean post-operative DASH was 3.62. 6% of patients sustained a major complication. Intramedullary screw fixation of proximal phalangeal fractures is safe, providing stable fixation to allow early motion.No Full Tex

Temporal trends in the management of metacarpal and phalangeal fractures in the 21st century: an analysis of Australian population-based data

Background: Fractures of the hand, specifically the metacarpals and phalanges, are a common injury. Whilst many of these fractures can be treated non-operatively, a number of advances have led to the increase in popularity of surgical intervention. The aim of this study was to assess and describe trends in management of phalangeal and metacarpal fractures in Australia over the last two decades. Methods: A review was conducted of the Medicare Benefits Scheme (MBS), specifically querying the item numbers pertaining to the management of metacarpal and phalanx fractures. Data was recorded as the incidence per 100 000 patients. Results: Overall, there was a statistically significant decrease in the incidence of closed reduction of metacarpal and phalanx fractures, with a converse statistically significant increase in open reduction internal fixation. Conclusion: This study demonstrates that over the last 20 years, there has been a decrease in closed reduction of intra- and extra-articular phalangeal and metacarpal fractures, with a converse but smaller increase in open reduction and fixation. These trends are likely multi-factorial in aetiology, and should be monitored to guide resource allocation and health provision in the future.No Full Tex

Anatomical Variability of Intercondylar Fossa Geometry in Patients Diagnosed with Primary Anterior Cruciate Ligament Rupture

The aims of this study were to (1) describe the three-dimensional characteristics and sources of anatomical variability in the geometry of the intercondylar fossa ("notch") in an anterior cruciate ligament (ACL)-injured sample and (2) assess the relationship between patient factors and anatomical variability of the fossa in the context of impingement risk. A retrospective analysis of preoperative magnetic resonance imaging (MRI) for 49 patients with ACL rupture was performed. Scans were examined in the axial plane using an online picture archiving and communication system (PACS) viewer and fossa width and angle assessed at multiple slices, as well as anteroposterior depth, fossa height, and calculated total volume. Principal component analysis was performed to prioritize the sources of variability. A multivariate linear regression was performed to assess relationships between different patient factors, controlling for imaging parameters and principal component loadings. Geometric properties were normally distributed for all but fossa volume, height, and distal angle. Three principal components (PCs) were identified explaining 80% of total variance, shape (PC1), size in the coronal plane (PC2), and size in the sagittal plane (PC3). Patient factors were significantly (P < 0.05) related to PC loadings; however, a substantial amount of variance in each model remained unexplained. Intercondylar fossa characteristics vary considerably within ACL-injury patients with shape and size in coronal and axial planes, explaining most of the variance. Although patient factors are associated with anatomical characteristics, further work is required to identify the correct combination of factors accurately predicting geometry of the fossa for planning ACL reconstruction. Clin. Anat.No Full Tex