Transfer Validity of Pediatric Supracondylar Humeral Fracture Pin Placement Practice on In-Theater Performance by Orthopedic Trainees Using an Augmented Reality Simulator: Protocol for a Pilot Interventional Cohort Study With a Retrospective Comparator Cohort.

BACKGROUND: Supracondylar humeral fractures (SCHF) are a common cause of orthopedic morbidity in pediatric populations across the world. The treatment of this fracture is likely one of the first procedures involving x-ray-guided wire insertion that trainee orthopedic surgeons will encounter in their career. Traditional surgical training methods of "see one, do one, teach one" are reliant on the presence of real-world cases and must be conducted within an operative environment. We have developed an augmented reality simulator that allows trainees to practice this procedure in a radiation-free environment at no extra risk to patients. OBJECTIVE: This study aims to examine whether training on a simulator in addition to traditional surgical training improves the in-theater performance of trainees. METHODS: This multicenter, interventional cohort study will involve orthopedic trainees from New Zealand in their first year of advanced training between 2019 and 2023. Advanced trainees with no simulator exposure who were in their first year in 2019-2021 will form the comparator cohort, while those in the years 2022-2023 will receive additional regular simulator training as the intervention cohort. The comparator cohort's performance in pediatric SCHF surgery will be retrospectively audited using routinely collected operative outcomes and parameters over a 6-month period. Data on the performance of the intervention cohorts will be collected in the same way over a comparable period. The data collected for both groups will be used to determine whether additional training with an augmented reality training shows improved real-world surgical outcomes compared to traditional surgical training. RESULTS: As of February 2022, a total of 8 retrospective comparator trainees have been recruited by email. The study is financially supported through an external grant from the Wishbone Orthopaedic Research Foundation of New Zealand (September 2021) and an internal research grant from the University of Otago (July 2021). CONCLUSIONS: This protocol has been approved by the University of Otago Health Ethics committee (reference HD21/087), and the study is due for completion in 2024. This protocol may assist other researchers conducting similar studies in the field. TRIAL REGISTRATION: Australian New Zealand Clinical Trials Registry ACTRN12623000816651; https://tinyurl.com/mtdkecwb. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/38282.

Forced Disruption of Anatomy Education in Australia and New Zealand: An Acute Response to the Covid-19 Pandemic.

Australian and New Zealand universities commenced a new academic year in February/March 2020 largely with "business as usual." The subsequent Covid-19 pandemic imposed unexpected disruptions to anatomical educational practice. Rapid change occurred due to government-imposed physical distancing regulations from March 2020 that increasingly restricted anatomy laboratory teaching practices. Anatomy educators in both these countries were mobilized to adjust their teaching approaches. This study on anatomy education disruption at pandemic onset within Australia and New Zealand adopts a social constructivist lens. The research question was "What are the perceived disruptions and changes made to anatomy education in Australia and New Zealand during the initial period of the Covid-19 pandemic, as reflected on by anatomy educators?." Thematic analysis to elucidate "the what and why" of anatomy education was applied to these reflections. About 18 anatomy academics from ten institutions participated in this exercise. The analysis revealed loss of integrated "hands-on" experiences, and impacts on workload, traditional roles, students, pedagogy, and anatomists' personal educational philosophies. The key opportunities recognized for anatomy education included: enabling synchronous teaching across remote sites, expanding offerings into the remote learning space, and embracing new pedagogies. In managing anatomy education's transition in response to the pandemic, six critical elements were identified: community care, clear communications, clarified expectations, constructive alignment, community of practice, ability to compromise, and adapt and continuity planning. There is no doubt that anatomy education has stepped into a yet unknown future in the island countries of Australia and New Zealand.

Clinical anatomy e-cases: a five-year follow-up of learning analytics.

AIM: This article explores the development and user experiences of a supplementary e-learning resource (clinical anatomy e-cases) for medical students, across a five-year teaching period. METHODS: A series of online supplementary e-learning resources (the clinical anatomy e-cases) were developed and introduced to the regional and clinical anatomy module of the medicine course. Usage analytics were collected online from a cohort of third-year medical students and analysed to gain a better understanding of how students utilised these resources. RESULTS: Key results showed that the students used the supplementary learning resource during and outside regular teaching hours that includes a significant access during holidays. Analysis also suggested that the resources were frequently accessed during examination periods and during subsequent clinical study years (fourth or fifth years of medicine course). Increasing interest and positive feedback from students has led to the development of a further series of e-cases. CONCLUSION: Tailor-made e-learning resources promote clinical anatomy learning outside classroom hours and make supplementary learning a 24/7 task.

Position Effect on Facial Soft Tissue Depths: A Sonographic Investigation.

The head is positioned erect for an approximation; yet most facial soft tissue depths (FSTD) used are measured from supine subjects. Depth difference might be significant, but there is a paucity of data to verify. This study compared erect and supine values for 17 landmarks from 30 healthy New Zealand (European population affinity) women (18-30 or 40-55 years) in erect then supine positions. Height, weight, and sonographic FSTD data, totaling 1020 measurements, were obtained. Three midline and seven averaged bilateral values were compared using ANOVA, p values, and Pearson's correlations. Correlative strength of age and body mass index, BMI (kg/m(2) ), was determined by values. Results showed averaged erect and supine differences were significant for four of ten FSTDs. Between individuals, difference was various and not unidirectional. In conclusion, depth differences were observed but not all significant or unidirectional, BMI significantly influenced nine FSTD values, but age group did not.

Ancestry and BMI Influences on Facial Soft Tissue Depths for A Cohort of Chinese and Caucasoid Women in Dunedin, New Zealand.

This study measured and assessed facial soft tissue depths (FSTDs) in adult female Chinese and New Zealand (NZ) Europeans (Caucasoids). Ultrasound was used to obtain depths at nine landmarks on 108 healthy subjects (51 Chinese, 57 NZ European), erect positioned, of same age group (18-29 years). Height and weight were also recorded. Statistical analysis focused on comparison of tissue depth between the two ancestry groups and the influence of Body Mass Index (BMI) (kg/m2). Results showed mean depth differences at Supra M2 and Infra M2 landmarks significantly greater for Chinese than Caucasoid women for all three BMI Classes (BMI<20, 20≤BMI<25, 25≤BMI<30), even BMI<20. For both groups BMI positively correlated with FSTD values at all landmarks except Labrale superius. This study enabled ancestry and BMI influence on FSTDs to be observed and compared for two distinct groups. Results add to knowledge about facial tissue depth variation.

Screw placement after pinning of slipped capital femoral epiphysis: a postoperative CT scan study.

BACKGROUND: Unrecognized pin penetration in the treatment of slipped capital femoral epiphysis has serious long-term sequelae. The purpose of this study was to use postoperative computerized tomographic (CT) scans to determine the true position of the screw tip when compared with standard radiograph views. METHODS: Twenty-four patients with 33 slipped capital femoral epiphyses were included in the study. Intraoperative or postoperative radiographs [anteroposterior (AP) and frog lateral] were compared with postoperative CT scans (coronal and axial) to determine (1) distance of the screw tip from the subchondral bone of the femoral head, (2) the number of screw threads across the physis, and (3) the 3-dimensional placement of the screw tip in the femoral head. RESULTS: The positions of 38 screws in 33 hips were assessed. Screw position within specific quadrants of the femoral head was more anterior and superior than appreciated on radiographs. AP radiographs overestimated the distance between the screw tip and the subchondral bone, the average distance being 5.5 mm on AP radiographs and 3.4 mm on coronal CT (P<0.0001). Bland-Altman analysis confirmed 95% limits of agreement of -5.6 to 1.5 mm, indicating that screws could be up to 5.6 mm closer to the subchondral bone than estimated by the AP radiograph. Closer agreement was found between the frog lateral radiograph and the axial CT views, with the distance from the subchondral bone averaging 4.7 mm on frog lateral radiographs and 4.1 mm on axial CT (P<0.01). Bland-Altman analysis showed 95% limits of agreement between the 2 measures of -3.5 to 2.3 mm, suggesting that some screws were up to 3.5 mm closer to the subchondral bone. Three more anteriorly placed screws seemed to penetrate subchondral bone on CT, findings not shown on standard radiographs. CONCLUSIONS: Frog lateral radiographs of the hip provide a more accurate estimation of screw placement than AP radiographs. Screws closer than 4 mm to the subchondral bone on frog lateral radiographs or 6 mm on AP radiographs may penetrate subchondral bone.

A comparison of embalming fluids for use in surgical workshops.

There is a growing need to learn surgical skills without risk to patients. One of the major determining factors on the suitability of specimens for surgical workshops is the fluid used for embalming. This study sought to compare three different arterial embalming preparations to a single fresh cadaver. Eleven cadavers embalmed using Graz (single cadaver), Dodge (four cadavers) and Genelyn (five cadavers) preparations were compared using four criteria; joint flexibility measured with a goniometer, tissue pliability rated on standardized videos of instrument handling, tissue color analyzed on standardized photographs and resistance to fungal growth identified by inoculation and observation of tissue blocks. The cadaver embalmed according to the Graz method had joint flexibility comparable to fresh tissue while the Dodge and Genelyn cadavers were less flexible. Tissue pliability was significantly affected by the Dodge and Genelyn methods while the Graz method tissue remained most like fresh tissue. The Graz method cadaver had color that was most akin to fresh tissue and the Dodge method cadavers were relatively more like fresh than the Genelyn. The Dodge and Genelyn method had quite similar fungicidal properties (3/11 Dodge and 2/9 Genelyn embalmed cadavers susceptible) while the Graz method cadaver did not grow mould. Variation exists between cadavers; however, the Graz method produced a cadaver with more flexible joints, better tissue quality and muscle color closest to the fresh specimen. The Dodge and Genelyn methods are similar with the exception of tissue color where the Dodge method was more similar to fresh tissue.

Is the cranial accessory nerve really a portion of the accessory nerve? Anatomy of the cranial nerves in the jugular foramen.

The accessory nerve is traditionally described as having both spinal and cranial roots, with the spinal root originating from the upper cervical segments of the spinal cord and the cranial root originating from the dorsolateral surface of the medulla oblongata. The spinal rootlets and cranial rootlets converge either before entering the jugular foramen or within it. In a recent report, this conventional view has been challenged by finding no cranial contribution to the accessory nerve. The present study was undertaken to re-examine the accessory and vagus nerves within the cranium and jugular foramen, with particular emphasis on the components of the accessory nerve. These nerves were traced from their rootlets attaching to the spinal cord and the medulla and then through the jugular foramen. The jugular foramen was exposed by removing the dural covering and surrounding bone. A surgical dissecting microscope was used to trace the roots of the glossopharyngeal nerve (CN IX), vagus nerve (CN X) and accessory nerve (CN XI) before they entered the jugular foramen and during their travel through it. The present study demonstrates that the accessory nerve exists in two forms within the cranial cavity. In the majority of cases (11 of 12), CN XI originated from the spinal cord with no distinct contribution from the medulla. However, in one of 12 cases, a small but distinct connection was seen between the vagus and the spinal accessory nerves within the jugular foramen.

Anatomical variations of the common carotid artery bifurcation.

BACKGROUND: The correlation of the common carotid artery (CCA) bifurcation and its surrounding structures is poorly described. The aim of this study was to describe the anatomy of the CCA bifurcation relative to its surrounding structures. METHOD: We dissected a total of 67 carotid specimens from 36 embalmed cadavers. CCA bifurcation occurred at the superior border of thyroid cartilage in 39% and at the body of hyoid bone in 40% of specimens. RESULTS: The superior thyroid artery arose more commonly from the CCA (52.3%) than the external carotid artery (46.2%). The vagus nerve was posterior to the carotid bifurcation in 40 (60%), posterior-lateral in 24 (36%), posterior-medial in 2 (3%) and anterior-lateral in 1 specimen (1.5%). The hypoglossal nerve was closer to the CCA bifurcation when the CCA bifurcated at the level of the hyoid bone than when it bifurcated at the superior border of the thyroid cartilage (P < 0.05). The correlation of the common facial vein and the carotid artery was highly variable. CONCLUSION: The presence of a high CCA bifurcation should caution surgeons that the hypoglossal nerve lies in closer proximity and is more vulnerable. Preoperatively documenting the level of the CCA bifurcation may be helpful in identifying those patients at increased risk of iatrogenic injury.

Surgical inclination in senior medical students from the University of Auckland: results of the 2005 Senior Students Survey.

AIMS: To determine the proportion of senior medical students who are surgically inclined and to assess whether gender differences exist in surgical inclination. STUDY DESIGN: Cross-sectional survey. Twenty-five point questionnaire. Likert scale response ranking. SETTING: University of Auckland Medical School, New Zealand. PARTICIPANTS: 218 surveys were emailed to functioning addresses of fourth and fifth year students.156 students emailed responses (71.60% response rate). RESULTS: Twenty percent of students were found to be surgically inclined (95% CI 0.15-0.26). The proportion of surgically inclined males was significantly higher than females (p<0.01). A greater proportion of surgically inclined students found time spent in the operating theatre educationally valuable than non-surgically inclined students (p<0.01). No difference exists in the number of different procedures undertaken by students (p<0.05). CONCLUSION: Males are significantly more likely to be surgically inclined than females at the University of Auckland Medical School.

Surgical inclination and anatomy teaching at the University of Auckland.

BACKGROUND: Medical graduate interest in surgery has declined and medical students are less capable in anatomy than they once were. Declining interest in surgery is because of factors, including growing number of women entering medical school. There has been less emphasis in teaching anatomy at various medical schools in recent years. The aim of this study is to quantify surgical inclination in Auckland medical students to assess whether gender differences exist in surgical inclination and determine confidence in anatomy knowledge and resources used by Auckland medical students. METHOD: Survey design was cross-sectional and included 25-point questionnaire using Likert scale response ranking and tick box replies. Two hundred and eighteen surveys were emailed to functioning addresses of fourth and fifth year students at University of Auckland, School of Medicine, New Zealand. RESULTS: Response rate was 71.6%. Twenty per cent of students were found to be surgically inclined (95% confidence interval, 0.15-0.26). The proportion of surgically inclined men was significantly higher than women (P < 0.05). Thirty-three per cent of all respondents (95% confidence interval, 0.26-0.41) felt their knowledge of anatomy was adequate to practice medicine safely. Textbooks and atlases were most commonly used to learn anatomy (P < 0.05). Radiology was the least commonly used method to learn anatomy (P < 0.05). Eighty-seven per cent (95% confidence interval, 0.81-0.92) of respondents agreed that revisiting dissection during surgical attachments would be helpful. CONCLUSION: Men are significantly more likely to be surgically inclined than women at the University of Auckland. A significantly greater proportion of students felt that their knowledge of gross anatomy was inadequate for safe medical practice. Students use traditional methods to learn anatomy more commonly than radiological methods. The majority of students surveyed would like to revisit cadaver dissection during clinical attachments in surgery.

Basic science confidence in senior medical students from the University of Auckland, New Zealand: results of the 2005 Senior Students Survey.

AIMS: To determine the proportion of senior medical students who feel their knowledge of the basic sciences is adequate for safe medical practice. DESIGN: Cross-sectional survey. Twenty-five point questionnaire. Likert scale response ranking. SETTING: University of Auckland School of Medicine, Auckland, New Zealand. PARTICIPANTS: 218 surveys were emailed to functioning addresses of fourth and fifth year students. 156 students emailed responses (71.60% response rate), comprising 55% of the total fourth and fifth year student population. RESULTS: Thirty-three percent of respondents (95% CI 0.26-0.41) felt their knowledge of anatomy was adequate. Seventeen percent (95% CI 0.12-0.24) of students felt their knowledge of pharmacology was adequate. Fifty-six percent (95% CI 0.48-0.64) of all respondents felt their knowledge of physiology was adequate. Forty-six percent (95% CI 0.38-0.54) of all respondents felt their knowledge of pathology was adequate Seventy-six percent (95% CI 0.69-0.83) felt their behavioural science knowledge was adequate. A greater proportion of respondents were confident in behavioural science than any other basic science (p<0.01). CONCLUSION: Respondents to the 2005 senior medical students survey from the University of Auckland School of Medicine are most confident in their behavioural sciences knowledge. Respondents are least confident in their knowledge of pharmacology.