Application of modified mini-clinical evaluation exercise in the cultivation of orthopaedic students.

OBJECTIVE: To apply the mini-clinical evaluation exercise (Mini-CEX) to orthopaedics and check its influence on clinical operational abilities and thinking abilities. METHODS: The original Mini-CEX was modified to fit orthopaedics, and another Mini-CEX was established to test interns' clinical operational abilities. A total of 39 interns had to complete two types of Mini-CEX twice, once at the beginning and once at the end of the internship. Clinical supervisors collected all the scores and analysed the differences in the average scores between the first and second assessments. The interns were divided into Qualified teacher group and Excellent teacher group according to their Mini-CEX scores. RESULTS: The results of the Mini-CEX examination of the two groups were compared. Researchers found a significant difference between the two assessments on seven domains (all P < 0.05). The scores at the end were higher than those at the beginning, which indicated that the interns' clinical thinking and operational abilities had improved. The average scores of the interns in the Excellent teacher group were significantly higher than those of interns in the Qualified teacher group. CONCLUSIONS: The modified Mini-CEX is suitable for orthopaedic education and could help cultivate interns' clinical thinking ability.

[Combination of volar buttress plate with external fixator for the distal radial fractures of type C3 caused by high-energy injuries].

OBJECTIVE: To preliminarily explore the effect of combination of volar buttress plate with external fixator for the distal radial fractures of type C3 caused by high-energy injuries. METHODS: From January 2001 to June 2007, 13 patients with distal radial fracture of type C3, 9 males and 4 females aged from 26 to 47 (average 37 years), were treated with volar buttress plate combined with external fixator plus the techniques of K-wires and bone grafting as necessary, whose effects were evaluated preliminarily through comparing the volar tilt, radial inclination, radial shortening and wrist function. RESULTS: Followed up from 7 to 29 months (average 18 months), the volar tilt, radial inclination, radial shortening and wrist function of all patients recovered remarkably. Nine patients achieved excellent and 4 good according to Sarmiento score (modified by Stewart) in the radiological manifestation, while 5 patients displayed excellent, 6 good, and 2 fair according to Gartland-Werley functional assessment system. CONCLUSION: 1) Volar buttress plate could support the valor cortex in order to prevent comminuted fragment from displacing and maintain volar tilt and to provide the volar fulcrum for external fixator. 2) External fixator, with the assistance of volar fulcrum, could maintain the volar tilt and the height of distal radius and help unload the fossa. 3) Supplemental K-wires fixation and the bone graft may assist fracture stable.