Evaluation of four techniques for injection of the proximal interphalangeal joint in horses.

OBJECTIVE: To describe a dorsoproximal midline (DPM) standing technique for proximal interphalangeal joint (PIPJ) injection and to compare it to established dorsolateral flexed (DLF), palmaroproximal (PP), and dorsolateral standing (DLS) techniques. STUDY DESIGN: Ex vivo study. SAMPLE POPULATION: Sixty cadaver equine thoracic limbs. METHODS: Limbs were divided into four groups (n = 15 each group), DLF, DPM, PP, and DLS. For each technique, three operators injected radiopaque contrast and methylene blue into the PIPJ in five limbs. The number of attempts required was recorded. Successful injection was confirmed by radiographic presence of contrast media within the PIPJ. Iatrogenic cartilage damage was assessed by gross examination. Statistical analysis was performed by Wilcoxon signed-rank test (P < .05). RESULTS: The overall success rates were 86.6% to 93.3%. Although there was no difference in success rate, the frequency of needle repositioning was influenced by injection technique (P = .009). Dorsolateral standing had the highest mean ± SD value of attempts required to insert the needle in the joint space (2.62 ± 1.94). Injection technique influenced cartilage damage (P = .025), with the highest frequency recorded for DLS. CONCLUSION: All four techniques for injecting the PIPJ were highly successful; DLS was associated with the highest number of needle repositionings and the highest incidence of iatrogenic injury to cartilage. CLINICAL SIGNIFICANCE: Dorsolateral flexed should be considered as an alternative to the DLS technique to reduce iatrogenic cartilage injury when injecting the PIPJ. Dorsoproximal midline and DLF techniques have success rates comparable to traditional techniques, with lower incidence of iatrogenic cartilage damage in cadaver limbs.

Teaching and proficiency assessment for arthroscopy in veterinary surgery: A 2017 survey of diplomates and residents of the American and European College of Veterinary Surgeons.

OBJECTIVE: To determine current methods of arthroscopic skills training and proficiency assessment, identify skills considered fundamental to arthroscopy, and evaluate desire for a formal training and assessment program. STUDY DESIGN: Anonymized electronic survey. SAMPLE POPULATION: Diplomates and residents of the American College of Veterinary Surgeons (ACVS) and European College of Veterinary Surgeons (ECVS). METHODS: An electronic survey was distributed in commercial software (Qualtrics, Provo, Utah). Questions were divided into 4 categories: (1) demographics, (2) arthroscopy experience, (3) teaching, and (4) proficiency assessment. Descriptive statistical analysis was performed. Comparisons between groups were performed by using χ2 , t tests, and 1-way ANOVA (P ≤ .05). RESULTS: In total, 429 diplomates and 149 residents responded (response rate 28%). Overall, 80% of respondents trained using clinical cases. Barriers to simulator training included cadaver/simulator availability and time. Skills deemed most fundamental included anatomic knowledge, precise portal placement, triangulation, and image orientation. Overall, 90% of respondents supported a formal training program with requirement to demonstrate proficiency; 80% believed this should be part of standard ACVS/ECVS residency training. CONCLUSION: Arthroscopic skills are taught by using clinical cases, with subjective proficiency assessment. Fundamental skills are those that may be taught using simulators. There is enthusiasm for formal arthroscopic skills training and assessment. CLINICAL SIGNIFICANCE: Improved acquisition and assessment of fundamental arthroscopic skills is indicated. A validated methodology for formal training using simulators, minimizing morbidity, and facilitating objective evaluation is warranted. This is the first phase of a project to develop and validate a simulator program.