Analysis of a multifaceted interactive pedagogy program in an upper limb anatomy course: A time series study.

Many new methods have contributed to the learning of anatomy, including several interactive methods, increasing the effectiveness of educational programs. The effectiveness of an educational program involving several interactive learning methods such as problem-based learning and reciprocal peer teaching was researched in this study. A quasi-experimental before-after study on three consecutive groups of second-year students at the Grenoble School of Medicine was conducted. The lectures were replaced by an educational program based on the problem-based learning method and reciprocal peer teaching. The first session was dedicated to reading clinical cases illustrating the medical concept, so that the learning objectives for the second session could be set. Then, after viewing digital courses, the second session was dedicated to a synthetic presentation by the students themselves, followed by an interactive summary with the teacher. The analysis of 630 students showed a significant increase in the theory test results for those who took part in the intervention: 9.71 versus 9.19 (ß = 0.57, P = 0.036). Moreover, satisfaction was high after the intervention (mean = 4.5/5), and when comparing the two pedagogical approaches the students showed a clear preference for the program implemented with the concepts highlighted such as interactivity, in-depth work, group work, and autonomy. A multifaceted interactive pedagogy program could have a significant impact on the results of the theoretical concepts presented and on satisfaction as well as increased investment by students in learning anatomy.

Navigated Cementoplasty With O-Arm and Surgivisio: An Ambispective Comparison With Radiation Exposure.

BACKGROUND: Vertebral compression fractures (VCF) are usually treated by cementoplasty. Computerized navigation allows more accurate surgery without additional imaging acquisition for guidance and related radiation exposure. New technologies trend to optimize the irradiation for patients and surgeons. The objective was to investigate the radiological results and radiation exposure of O-arm navigation compared with the all-in-one 2-dimensional/3-dimensional (2D/3D) Surgivisio device in navigated cementoplasty procedures. METHODS: Patients in the O-arm group comprised an O-arm prospective cohort as well as previous patients. Operations for VCF by navigated cementoplasty took place over 18 months. Patients in the Surgivisio group were the first patients operated on using Surgivisio and were prospectively recruited. Demographic, operative, and irradiation data were collected, as well as the image quality subjectively evaluated by the surgeon. The vertebal filling was evaluated using the Garnier classification and quoted as satisfactory, acceptable, or poor. The effective dose in millisievert (mSv) was calculated for radiation exposure estimation, and the absolute risk of cancer (AR) in percent equivalent to a whole-body irradiation was also calculated. RESULTS: A total of 123 patients were included: 62 in the O-arm group and 61 in the Surgivisio group. A total of 166 vertebrae were analyzed. Compared with the Surgivisio group, the effective dose was significantly higher in the O-arm group, with a mean of 11.47 vs 1.14 mSv, respectively (P < 0.001). The 2D part of the effective dose received by the surgeon was significantly higher in the O-arm group, with an average of 2.25 vs 0.47 mSv, respectively (P < 0.001). Overall AR followed the same trend, with a mean of 4.9 × 10-4% in the O-arm group and 5.7 × 10-5% in the Surgivisio group (P < 0.001). Operative time was significantly higher in the O-arm group (34.52 vs 30.12 minutes respectively, P = 0.03). Image quality was similarly sufficient in 3D, but in 2D, image quality was significantly better in the O-arm group (P = 0.01). Vertebral filling was significantly better in the O-arm group, with 100% of results reported as satisfactory and acceptable versus 85% in the Surgivisio group (P < 0.001). CONCLUSIONS: The O-arm delivered a 10-times higher effective dose during navigated cementoplasty in comparison with the Surgivisio device. The O-arm also had a longer operative time, but it had better image quality and radiological results.

Clinical and radiological outcomes of antegrade posterior column screw fixation of the acetabulum.

INTRODUCTION: Antegrade posterior column screw fixation (APCS) provides stable fixation while reducing the complications related to dual acetabular approaches. The objective of this study was to present the radiological and clinical outcomes of fixation of the posterior column of the acetabulum through a single anterior approach. HYPOTHESIS: APCS will produce better clinical and radiological outcomes relative to not placing any screws in the posterior column. PATIENTS AND METHODS: This was a retrospective single-center study of 69 patients operated through a single anterior approach for a both-column fracture of the acetabulum between 2014 and 2018. Patients were divided into two groups (APCS+, n=24 and APCS-, n=45) depending on whether the posterior column was fixed with an antegrade lag screw or not. The radiological outcomes were defined by the quality of the reduction according to Matta. The clinical outcomes were evaluated using the Harris Hip score and Merle Postel D'Aubigné (MDP) score at the final assessment. A sequential hierarchical analysis was done with a Chi2 test for the radiological criterion and Student's t test for the clinical outcomes. RESULTS: In the APCS+ group, the reduction was anatomical in 71% (17/24) of patients, imperfect in 12% (3/24) and poor in 17% (4/24). In the APCS- group, the reduction was anatomical in 33% (15/45) of patients, imperfect in 31% (14/45) and poor in 35% (16/45). This difference between groups was statistically significant (p=.012). The differences between groups in the Harris (p=.201) and MDP (p>.05) scores were not significant. Mean irradiation in the APCS+ group was significantly higher (114.8 cGy.cm-2) relative to the APCS- group (39.8 cGy.cm-2) (p<.001). None of the patients in the APCS+ group underwent a subsequent total hip arthroplasty, while 8 patients from the APCS- group did (p=.031). The differences in the postoperative complications were not statistically significant. DISCUSSION: APCS yields satisfactory radiological and clinical outcomes without increasing the complication rate; this must be balanced out against the additional irradiation. LEVEL OF EVIDENCE: III.

Effectiveness of a multifaceted intervention to improve interpersonal skills of physicians in medical consultations (EPECREM): protocol for a randomised controlled trial.

INTRODUCTION: Interpersonal skills, encompassing communication and empathy, are key components of effective medical consultations. Although many organisations have implemented structured training programmes, limited evidence exists on their effectiveness in improving physician interpersonal skills. This study aims to evaluate the effectiveness of a standardised, multifaceted, interpersonal skills development programme for hospital physicians. METHODS AND ANALYSIS: This study is a prospective, randomised (with a 1:1 allocation ratio), controlled, open-label, two parallel arm, superiority trial conducted at a single university hospital. Physicians will be randomised to receive either a multifaceted training programme or no intervention. The experimental intervention combines two 4-hour training sessions, dissemination of interactive educational materials, review of video-recorded consultations and individual feedback. The primary outcome measure is the overall 4-Habits Coding Scheme score assessed by two independent raters blinded to the study arm, based on video-recorded consultations, before and after intervention. The secondary outcomes include patient satisfaction, therapeutic alliance, physician self-actualisation and the length of medical consultation. ETHICS AND DISSEMINATION: The study protocol was approved on 21 October 2020 by the CECIC Rhône-Alpes Auvergne, Clermont-Ferrand, France (IRB 5891). All participants will provide written informed consent. Efforts will be made to release the primary results within 6 to 9 months of study completion, regardless of whether they confirm or deny the research hypothesis. TRIAL REGISTRATION NUMBER: NCT04703816.

A Systematic Review on Selected Complications of Open-Wedge High Tibial Osteotomy from Clinical and Biomechanical Perspectives.

BACKGROUND: The wedge opened during high tibial osteotomy defines the alignment correction in different body planes and alters soft tissue insertions. Although multiple complications of the surgery can be correlated to this, there is still a lack of consensus on the occurrence of those complications and their cause. The current study is aimed at clarifying this problem using a combined medical and biomechanical perspective. METHODS: We conducted a systematic review of the literature on selective complications of the surgery correlated with the angles of the opened wedge. Search topics covered tibial slope alteration, patellar height alteration, medial collateral ligament release, and model-based biomechanical simulations related to surgical planning or complications. Findings. The selection process with the defined inclusion/exclusion criteria led to the collection of qualitative and quantitative data from 38 articles. Medial collateral ligament tightness can be a valid complication of this surgery; however, further information about its preoperative condition seems required for better interpreting the results. The posterior tibial slope significantly increases, and the patellar height (using the Blackburne-Peel ratio) significantly decreases in the majority of the selected studies. Model-based biomechanical studies targeting surgical planning are mostly focused on the lower-limb alignment principles and tibiofemoral contact balancing rather than surgical complications. Interpretation. Increased posterior tibial slope, patellar height decrease, and medial collateral ligament tightness can occur due to alterations in different body planes and in soft tissue insertions after wedge opening. This study clarified that information about preoperative alignment in all body planes and soft-tissue conditions should be considered in order to avoid and anticipate these complications and to improve per surgery wedge adaptation. The findings and perspective of this review can contribute to improving the design of future clinical and biomechanical studies.

Screw-plate fixation for displaced middle-third clavicular fractures with three or more fragments: A report of 172 cases.

BACKGROUND: Although mid-shaft clavicular fractures are generally thought to be non-serious injuries that nearly always heal with non-operative treatment, recent studies found non-union rates of 3%-7% in simple fractures and 20%-33% in complex fractures. The primary objective of this study was to report the functional and anatomical outcomes after screw-plate fixation of displaced mid-shaft clavicular fractures with three or more fragments. HYPOTHESIS: Screw-plate fixation in this indication is an excellent treatment option that minimises the risk of complications. METHODS: A search of our database from 6 January 2012 to 27 December 2016 identified 410 cases of clavicular fracture, of which 250 were managed surgically, including 172 meeting our inclusion criteria and having complete data. These 172 patients were managed using a curved pelvic reconstruction plate with 3.5-mm non-locking screws positioned over the antero-superior aspect of the clavicle. All 172 patients were re-evaluated at least 1 year after surgery by an independent assessor, who determined the UCLA score. RESULTS: We studied 172 patients, 154 (89.5%) males and 18 females with a mean age of 34.5±14.5 years (range, 13-69 years). In 84.5% of cases, the fracture was a sports injury, and the most common sports were skiing (26%), cycling (21%), and mountain biking (18.5%). Of the 172 fractures, all but 1 healed, within a mean of 87 days (range, 45-120 days). After removal of the fixation material, 8 (4.5%) patients experienced a recurrent fracture, within a mean of 90 days (range, 2-210 days); 4 of these recurrent fractures were caused by high-energy traumas occurring 6 months after implant removal. The UCLA score determined at re-evaluation indicated that the outcome was excellent in 164 (95.5%), good in 5 (3%), and fair in 3 patients. CONCLUSION: Internal fixation using a curved pelvic reconstruction plate fixed with 3.5-mm screws provides excellent functional and anatomical outcomes in patients who have displaced mid-shaft clavicular fractures with three or more fragments. LEVEL OF EVIDENCE: IV, retrospective cohort study.