Development of a surgical skills curriculum for the training and assessment of manual skills in orthopedic surgical residents.

OBJECTIVE: To develop and conduct a pilot study of a curriculum of 4 surrogate bone training modules to assess and track progress in basic orthopedic manual skills outside the operating room. DESIGN: Four training modules were developed with faculty and resident input. The modules include (1) cortical drilling, (2) drill trajectory, (3) oscillating saw, and (4) pedicle probing. Orthopedic resident's performance was evaluated. Validity and reliability results were calculated using standard analysis of variance and multivariate regression analysis accounting for postgraduate year (PGY) level, number of attempts, and specific outcome target results specific to the simulation module. SETTING: St. Mary's Medical Center in San Francisco, CA. PARTICIPANTS: These modules were tested on 15 orthopedic surgery residents ranging from PGY 1 to PGY 5 experience. RESULTS: The cortical drilling module had a mean success rate of 56% ± 5%. There was a statistically significant difference in performance according to the diameter of the drill used from 33% ± 7% with large diameter to 70% ± 6% with small diameter. The drill trajectory module had a success rate of 85% ± 3% with a trend toward improvement across PGY level. The oscillating saw module had a mean success rate of 25% ± 5% (trajectory) and 84% ± 6% (depth). We observed a significant improvement in trajectory performance during the second attempt. The pedicle probing module had a success rate of 46% ± 10%. CONCLUSION: The results of this pilot study on a small number of residents are promising. The modules were inexpensive and easy to administer. Conclusions of statistical significance include (1) residents who could easily detect changes in surrogate bone thickness with a smaller diameter drill than with a larger diameter drill and (2) residents who significantly improved saw trajectory with an additional attempt at the module.

Achilles allograft reconstruction for recurrent dislocation in total hip arthroplasty.

Recurrent dislocation secondary to posterior soft tissue deficiency is a challenging complication of total hip arthroplasty. We describe the use of an Achilles allograft sling to improve hip stability. Eight patients treated with the sling were followed an average of 5 years. Seven patients had no recurrent instability and good postoperative range of motion. One graft failed in a patient with a neuropathic hip. Cadaveric biomechanical testing was also performed to investigate the stiffness and torque to failure of the sling in 6 specimens. Allograft slings can be used to improve hip stability. The technique is relatively easy to perform and does not limit postoperative range of motion. The graft decreases joint stiffness and has a greater torque to failure than the intact capsule.