[Conservative treatment of scaphoid fractures]. / De conservatieve behandeling van scafoïdfracturen.

Considering that pseudoarthrosis, or non-union, often occurs in patients with scaphoid fractures it is very important to start adequate treatment as soon as possible. On the basis of the literature, we advise immobilisation in a below-elbow cast, whereby the thumb is not immobilised and the wrist is in a slightly extended position. Despite the fact that non-dislocated fractures, at the very least, are usually consolidated within 4 weeks, we advise an immobilisation period of 6 weeks followed by clinical or radiological evaluation. If the fracture fails to consolidate, we advise prolonged immobilisation with two-weekly evaluation. There is no evidence in the literature of a positive effect of pulsed electromagnetic field therapy or pulsed low-intensity ultrasound therapy on healing of scaphoid fractures.

Windsurfing vs kitesurfing: Injuries at the North Sea over a 2-year period.

AIM: To analyze all windsurfing and kitesurfing (kiteboarding) injuries presented at our coastal hospital over a 2-year period. METHODS: Twenty-five windsurfers (21 male; aged 31 ± 8 years) and 32 kitesurfers (23 male; aged 29 ± 11 years) presented at our hospital during the 2-year study period. Various injury data were recorded, including transport to hospital and treatment. After a median follow-up of 16 mo (range, 7-33 mo), 18 windsurfers (72%) and 26 kitesurfers (81%) completed questionnaires on the trauma mechanisms, the use of protective gear, time spent on windsurfing or kitesurfing, time to return to sports, additional injuries, and chronic disability. RESULTS: Most patients sustained minor injuries but severe injuries also occurred, including vertebral and tibial plateau fractures. The lower extremities were affected the most, followed by the head and cervical spine, the upper extremities, and the trunk. The injury rates were 5.2 per 1000 h of windsurfing and 7.0 per 1000 h of kitesurfing (P = 0.005). The injury severity was the same between groups (P = 1.0). Less than 30% of the study population used protective gear. Kitesurfers had a higher number of injuries, and required transport by ambulance, inpatient hospital stay and operative treatment more often than windsurfers, but these differences were not statistically significant (P > 0.05). The median time to return to windsurfing and kitesurfing was 5 and 4 wk, respectively (P = 0.79). Approximately one-third of the patients in each group experienced chronic symptoms. CONCLUSION: Kitesurfing results in a significantly higher injury rate than windsurfing in the same environmental conditions but the severity of the injuries does not differ.

Learning curve on the TrEndo laparoscopic simulator compared to an expert level.

BACKGROUND: The aim of this study was to determine growth in trainee laparoscopic skill as recorded by the TrEndo laparoscopic simulator during a laparoscopic training course, compared to an expert level. METHODS: A prospective observational cohort study was conducted between February 1 and November 31, 2010. Trainees in laparoscopic surgery completed a basic laparoscopic suturing task on a laparoscopic box trainer at three successive assessment points during a laparoscopic training course. Experts were assessed only once to define an expert level. The TrEndo recorded four motion analysis parameters (MAPs) individually for each hand and the amount of time taken to complete the suturing task. RESULTS: Seventy-two residents and 56 experts were included in this study. Overall, the amount of time taken on the suturing task and seven out of eight MAPs significantly increased toward an expert level during the course, representing an improvement in task efficiency. During the first training day, the amount of time spent on the suturing task and five out of eight MAPs improved significantly. After the retention period, five out of eight MAPS demonstrated a significant improvement compared to the end of the first training day. CONCLUSIONS: Laparoscopic skill of trainees as recorded by the TrEndo laparoscopic simulator grows toward an expert level during a laparoscopic training course in a large and heterogeneous study group. Construct validity of the TrEndo is established.

Swim cast versus traditional cast in pediatric distal radius fractures: a prospective randomized controlled trial.

PURPOSE: Non-displaced distal radius fractures in children are traditionally treated in a forearm cast. However, a traditional cast does not tolerate getting wet, with skin lesions and bad smell as result. A Swim cast, which has the ability to dry quickly, is an airy cast that is applied using the MOKcast technique. We hypothesize that Swim casts contribute to higher patient satisfaction scores than traditional casts, without any adverse effects on fracture healing or skin condition. METHODS: A prospective, randomized, single-center, blinded study was conducted to compare traditional and Swim cast treatment in children aged 5-15 years with greenstick or torus fractures of the distal radius. Primary endpoint was the patient and parent satisfaction, as determined by a questionnaire. Secondary endpoints were radiographic and clinical bone healing and cast-related skin conditions. RESULTS: A total of 68 patients, divided into two treatment groups (traditional case and Swim cast; n = 34 per group). Baseline characteristics were similar between the groups. The overall satisfaction score (0-10) reported by the patients was 8.6 in the Swim cast group versus 7.5 in the traditional cast group (p < 0.002); the overall satisfaction score reported by the parents was 8.3 and 7.7, respectively (p < 0.02). There was no difference in radiographic or clinical healing between groups, and skin conditions also did not differ significantly between groups. CONCLUSION: In our patient group, treatment of non-displaced, pediatric, distal radius fractures by Swim cast yielded better patient satisfaction results compared to treatment with the traditional, cotton-lined cast, without adverse effects on fracture healing or skin condition.

Validation of a new box trainer-related tracking device: the TrEndo.

BACKGROUND: There is an increasing demand for structured objective ex vivo training and assessment of laparoscopic psychomotor skills prior to implementation of these skills in practice. The aim of this study was to establish the internal validity of the TrEndo, a motion-tracking device, for implementation on a laparoscopic box trainer. METHODS: Face validity and content validity were addressed through a structured questionnaire. To assess construct validity, participants were divided into an expert group and a novice group and performed two basic laparoscopic tasks. The TrEndo recorded five motion analysis parameters (MAPs) and time. RESULTS: Participants demonstrated a high regard for face and content validity. All recorded MAPs differed significantly between experts and novices after performing a square knot. Overall, the TrEndo correctly assigned group membership in 84.7 and 95.7% of cases based on two laparoscopic tasks. CONCLUSION: Face, content, and construct validities of the TrEndo were established. The TrEndo holds real potential as a (home) training device.