Minimally Invasive Plate Osteosynthesis (MIPO) Through the Posterior Approach for the Humerus: A Cadaveric Study.

Background Minimally invasive plate osteosynthesis (MIPO) has been effectively used in femur and tibia fractures. MIPO in the humerus is conducted by anterior (most commonly used), lateral, and posterior approaches. However, in the anterior approach, in distal humeral diaphyseal fractures, there is a lack of adequate room for screw placement in the distal fragment for good stability. In such cases, the posterior approach for MIPO may be a propitious treatment method. However, the literature on MIPO using the posterior approach for humeral diaphyseal fractures is limited. This study aimed to evaluate the feasibility of MIPO through the posterior approach and study the association of radial nerve injury with MIPO through the posterior approach for the humerus. Methodology This experimental study was conducted in the Department of Orthopedics, Himalayan Institute of Medical Sciences, Dehradun, Uttarakhand, India, and 20 cadaveric arms (10 right and 10 left) of 11 embalmed (formalin) cadavers were included (seven males and four females). Cadavers were placed prone on the dissection table. The posterolateral tip of the acromion and lateral epicondyle of the humerus were used as bony landmarks that were marked under C-Arm (Ziehm Imaging, Orlando, FL, USA) using K wires (Kirschner wires, Surgical Holdings, Essex, UK). Two incisions on the posterior part of the arm were made, and the radial nerve was identified at the proximal incision. After creating a submuscular tunnel, a 3.5 mm extraarticular distal humeral locking compression plate (LCP) was introduced over the posterior surface of the humerus and fixed to the humerus distally with one screw and then adjusted proximally and fixed to the humerus with another screw in the proximal window, followed by placement of couple more screws under C-Arm. After plate fixation, the dissection was completed to meticulously explore the radial nerve. The radial nerve was examined thoroughly for any injury sustained after completion of dissection, from the triangular interval to the lateral intermuscular septum where the nerve enters the anterior chamber. The position of the radial nerve with respect to plate holes was noted. The distance from the posterolateral tip of the acromion to the lateral epicondyle was measured as humeral length. The medial and lateral points where radial nerve passed over the posterior surface of the humerus were measured from the posterolateral tip of the acromion and compared with the humeral length. Results In this study, the radial nerve was lying over the posterior surface of the humerus for a mean distance of 52.161 ± 5.16 mm. The mean distance at which the radial nerve crossed the medial and lateral borders of the posterior surface of the humerus, measured from the posterolateral tip of the acromion, was 118.34 ± 10.86 mm (40.07% of humeral length) and 170 ± 12.30 mm (57.57% of humeral length), respectively, and the mean humeral length in this study was 295.27 ± 17.94 mm. The radial nerve and its branches were found to be intact in all cases. The radial nerve was related to the fifth, sixth, and seventh holes, with the nerve lying most commonly over the sixth hole (3.5 mm extraarticular distal humerus locking plate). Conclusions The posterior approach of MIPO in humeral fractures is a safe and reliable treatment modality with minimal risk of radial nerve injury. The radial nerve can be safely identified at the spiral groove using the bony landmarks described in our study.

Comparison of two formats for student evaluation of teacher effectiveness.

CONTEXT: Student evaluation of faculty is an essential part of the academic process. The study was designed to compare two formats of student evaluation of teachers (SETs) with a view to determine the method with minimum bias. AIMS: To compare student ratings of teacher effectiveness obtained from two different SET formats and determine factors contributing to the student bias. MATERIALS AND METHODS: Faculty members of first professional were evaluated by MBBS students using a SET-I questionnaire already in use. Faculty perceived types of bias were documented using a separate semi-structured questionnaire. Based on this, a second SET-II questionnaire with Likert scale was designed and filled out by the same students as before. The faculty was apprised of the scores granted to them, and their acceptance of the preferred SET format was determined with the help of another questionnaire. RESULTS: Ratings obtained from 71 students using both the SET-I and SET-II formats showed no difference. However, the level of students satisfaction with teacher effectiveness, compared with the total teacher score, indicated that when a score of the faculty was below 50%, the level of students satisfaction reduced considerably. The major causes of perceived negative bias identified were strictness, seniority, gender, classes taken, less interest in the subject, and lower student grades. SET-II was preferred by faculty but didn't eliminate all bias factors. CONCLUSIONS: Although it was not possible to remove all causes of bias from the modified student questionnaire, the faculty perception of bias affecting the students rating seems to be largely ungrounded as there was no difference between the scores obtained.

Implementation of an education development project in pathology to improve student competency-lessons learnt.

CONTEXT: Basic medical sciences and clinical teachings are not coordinated in the present medical education system. They are not taught keeping in mind the outcomes required at the time of actual handling of patients in the community. AIMS: An educational development project was implemented in the Department of Pathology with the aim that it will result in the student learning to link the pathophysiology of the disease to clinical scenarios and become fully competent for lifelong medical practice. SUBJECTS AND METHODS: The pathology teaching of the second professional batch was modified by starting with defining the desired outcomes/competencies in the student's knowledge, skills, and attitude which were then addressed by lectures, demonstrations, practical classes and small group activities where case scenarios and laboratory reports were included. The outcome was assessed by Objectively Structured Clinical/Practical Examination and multiple choice questions. Force field analysis, faculty and student interviews, and questionnaires were used to assess the factors affecting its implementation and impact. RESULTS: Totally 80 students of the 2(nd) Professional MBBS were exposed to a competency-based education development project. It was found that the system was appreciated by faculty and students, especially the integration with clinical scenarios. There were many factors which influenced the execution of this program, including motivation level of students and faculty, time, logistics and meticulous planning. CONCLUSIONS: There was a significant improvement in student's performance and satisfaction. Many factors including prior planning were a major determinant for the success of this education development project.

Periosteal osteoblastoma of the pelvis: a rare case.

Among the rare bone tumors, the osteoblastoma is a fascinating tumor. The rarity, the predisposition to occur in any bone and the diagnostic dilemma makes this infrequent tumor interesting. It is sporadically reported in the literature and what is rarer is its occurrence in the pelvis. The unusual location and inconclusive radiographic findings with diffused diagnostic evidences delays the management of benign osteoblastoma. We encountered a patient with benign osteoblastoma of the pubic ramus of right side. An excisional biopsy was performed. Peroperatively, the tumor appeared as oval, reddish brown, bony hard mass lying just over the cortex of the right pubic ramus and not breaching the cortex. Histopathological study revealed an osteoid rich lesion. Its presence in pubis must not be ignored and periosteal osteoblastoma should be considered as a differential diagnosis.

Vacuum Assisted Closure Therapy versus Standard Wound Therapy for Open Musculoskeletal Injuries.

Background. This study was performed to evaluate the results of vacuum assisted wound therapy in patients with open musculoskeletal injuries. Study Design and Setting. Prospective, randomized, and interventional at tertiary care hospital, from 2011 to 2012. Materials and Methods. 30 patients of open musculoskeletal injuries underwent randomized trial of vacuum assisted closure therapy versus standard wound therapy around the upper limb and lower limb. Mean patient age was 39 ± 18 years (range, 18 to 76 years). Necrotic tissues were debrided before applying VAC therapy. Dressings were changed every 3 or 4 days. For standard wound therapy, debridement followed by daily dressings was done. Data Management and Statistical Analysis. The results obtained were subjected to statistical analysis. Results. The size of soft tissue defects reduced more than 5 mm to 25 mm after VAC (mean decrease of 26.66%), whereas in standard wound therapy, reduction in wound size was less than 5 mm. A free flap was needed to cover exposed bone and tendon in one case in standard wound therapy group. No major complication occurred that was directly attributable to treatment. Conclusion. Vacuum assisted wound therapy was found to facilitate the rapid formation of healthy granulation tissue on open wounds in the upper limb and lower limb, thus to shorten healing time and minimize secondary soft tissue defect coverage procedures.