Defining Cephalomedullary Nail Breakage Rates: A Systematic Review and Meta-Analysis.

OBJECTIVE: To establish the background rate of breakage of cephalomedullary nails. DATA SOURCES: MEDLINE, PubMed, and Web of Science were searched on April 3, 2023. STUDY SELECTION: All English-language studies that examined trochanteric with or without subtrochanteric fractures and identified cephalomedullary nail breakage as an outcome measure and a breakage rate could be derived were included. Implants captured were predominantly the TFNA, TFN, and PFN by DePuy Synthes, various versions of the Gamma nail by Stryker, the Zimmer Natural Nail by Zimmer Biomet, and the Intertan by Smith and Nephew. DATA EXTRACTION: The author, year of publication, dates of implant insertion, study design, method of detection of breakages, implant used, number of implant breakages, number of implants inserted, breakage rate, and follow-up were extracted. DATA SYNTHESIS: Meta-analysis of included studies used descriptive nonparametric statistics and a noncomparative proportion for the pooled result. Differences in results between study design types were compared using the mean breakage rate per study design. CONCLUSIONS: Cephalomedullary nail breakage is a rare complication with a median reported rate of 0.6% and a pooled result rate of 0.4%. Ninety-five percent of studies had a breakage rate of 1.3% or less, which sets a benchmark from the reported literature for future studies. There is wide variability in rates of breakage reported between different types of study designs with single-center review studies reporting breakage rates nearly 4-fold greater than large-scale administrative database reviews. The rate of implant breakage should not be used in isolation to judge an implant's performance. LEVEL OF EVIDENCE: Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.

Utility assessment of virtual reality technology in orthopaedic surgical training.

BACKGROUND: Virtual reality (VR) has proved to be a useful technology beyond the field of surgery in areas that are highly dependent on consolidating motor tasks. Despite being reliant on these skills, the uptake of VR in orthopaedics has been extremely limited. Therefore, this study's purpose was to help assess the utility of applying this technology in teaching different experience levels of orthopaedic training. Secondary objectives were to assess enjoyability and feasibility to complete modules prior to surgery. METHODS: The study explored which experience level of orthopaedic trainee benefits the most from the proposed haptic VR package. Participants completed a total hip arthroplasty module using the Fundamental Surgery package. Qualitative data was collected in the form of a post completion survey of 24 participants. Quantitative data was collected in the form of module completion time and percentage of skills completed. RESULTS: 37.5% of participants rated non-training orthopaedic registrars as the experience level that would benefit the most from using VR. 88% of participants would recommend this module to a colleague and found the module very enjoyable (4.2 out of 5). 50% of participants took between 25 and 31.5 min to finish and completed between 80% and 95% of tasks in the module. CONCLUSIONS: The study demonstrated that non-training orthopaedic registrars were most likely to benefit using this particular VR package. Most users found the experience to be enjoyable and would recommend it to a colleague. It was also deemed feasible to complete the module prior to performing an operation.

Rationale and feasibility assessment of an institution-based virtual reality hub in orthopaedic surgical training: an Australian pilot study.

BACKGROUND: Virtual reality (VR) has been established as a valuable tool outside of medicine but there has been limited uptake in orthopaedics despite being a specialty heavily dependent on psychomotor skills. The purpose of this study was to assess the feasibility of setting up an on-site virtual reality surgical training hub for an orthopaedic surgery unit. A secondary objective was to document encountered hurdles to assist other institutions with a similar process. METHODS: The study explored the logistical and organizational considerations in the process of creating a virtual reality training area. This included: review of location, set up management, funding arrangements, set up time, research opportunities and training time. Set up and completion times were recorded during a separate trial of 24 participants ranging from medical students to senior consultant orthopaedic surgeons. RESULTS: A VR training area was successfully established over a period of 3 months. A dedicated area for training where the equipment remains permanently was designated to facilitate ease of use. Average set up took 7.5 min to turn the computer on and 25 min for the participants to start the module. Issues identified during set up were recorded. CONCLUSIONS: The study demonstrated that it is possible to set up a dedicated area for virtual reality surgical training within a hospital unit. A dedicated lockable area is the most feasible method of establishing such a space and reduces the requirement to recalibrate and transfer equipment around the hospital.