Design and validation of 2 objective structured clinical examination stations to assess core undergraduate examination skills of the hand and knee.

OBJECTIVE: To evaluate the development, validity, and reliability of 2 undergraduate Objective Structured Clinical Examination (OSCE) stations for core hand and knee examination skills. METHODS: Two OSCE stations for hand and knee based on core skills were developed, and qualitatively assessed for face and content validity by an expert consensus panel. Construct validity was evaluated by comparing the performance of third- (n = 21) and fifth-year (n = 50) medical students with 6 specialist registrars (SpR) in rheumatology. Concurrent validity was evaluated by correlating the scores of the fifth-year students with their eventual final examination scores. The fifth-year data were used to calculate the interrater and intrarater reliabilities of 2 examiners. Intrarater reliability analyzed repeat scores using videotapes of the examinations. RESULTS: Both stations were deemed to fulfil face and content validity criteria by the expert consensus panel. There was no significant difference in the mean scores of the third- and fifth-years. There were significant differences in the mean scores between both student groups and the SpR in both stations consistent with a valid construct theory. The fifth-year hand OSCE results correlated moderately with other indices of clinical skills, but not knowledge, and satisfied concurrent validity. Inter- and intrarater reliability for both stations was high. CONCLUSION: These OSCE stations are valid and reliable tools for testing competency in core hand and knee examination skills. They can be used in educational research as outcome measures of specific teaching interventions and can also be used as an early feedback tool when teaching joint examination.

Application of computer-generated stereolithography and interpositioning template in acetabular fractures: a report of eight cases.

To determine the effectiveness of stereolithography modeling technologies in the surgical treatment of complex acetabular fractures, five patients with a complex fracture of the acetabulum and three patients with posterior wall fractures were considered in this study. The patients were surgically treated using an interposition template for accurate positioning of the fixation plate and screw trajectories. Intraoperative fluoroscopy confirmed precise plate placement and that all screw trajectories missed the hip joint. Fluoroscopy was only needed for confirmation of fracture reduction and for confirmation of screw location. Application of a life-size stereolithographic model of the pelvis and an interpositioning template along with the computer model of the reversed nonfractured contralateral hemipelvis provides an effective means for preoperative planning and accurate fixation of acetabular fractures. Further studies with this type of preplanning equipment may show a decrease in operative time and morbidity, decrease in radiation exposure, and improvement in accuracy of plate and screw placement.

Retrograde Nailing of Femur Shaft Fractures Through the Intercondylar Notch for Specific Indications: 10 Years Experience.

Closed antegrade intramedullary nailing is the current standard of care for the treatment of femoral shaft fractures. This technique has been shown to have excellent results demonstrated by a high rate of fracture union and the low incidence of infection. However, there are complications specific to antegrade intramedullary nailing, as well as specific injury patterns that make this treatment less attractive.