Effectiveness of ultraporous ß-tricalcium phosphate (vitoss) as bone graft substitute for cavitary defects in benign and low-grade malignant bone tumors.

We retrospectively evaluated healing with ultraporous ß-tricalcium phosphate (ß-TCP [Vitoss; Orthovida, Malvern, Pennsylvania]) bone graft in patients who underwent surgical excision or curettage of benign bone lesions subsequently filled with bone void filler. Twentynine patients were treated with curettage and ultraporous ß-TCP morsels. Radiologic defect size at initial postoperative presentation and subsequent visits (minimum follow-up, 6 months) was evaluated. Results suggested that an ultraporous ß-TCP synthetic bone graft is effective in managing bone voids. The vast majority of patients who undergo curettage for benign bone lesions can expect to have complete or near complete healing of these defects within 6 months of their surgical procedure with use of ultraporous ß-TCP morsels.

Implementation of an objective structured clinical exam (OSCE) into orthopedic surgery residency training.

OBJECTIVE: While the musculoskeletal (MSK) physical examination (PE) is an essential part of a patient encounter, we believe it is an underemphasized component of orthopedic residency education and that resident PE skills may be lacking. The purpose of this investigation was to (1) assess the attitudes regarding PE teaching in orthopedic residencies today; (2) develop an MSK objective structured clinical examination (OSCE) to assess the MSK PE knowledge and skills of our orthopedic residents. DESIGN: Prospective, uncontrolled, observational. SETTING: A major Midwestern tertiary referral center and academic medical center. PARTICIPANTS: The orthopedic surgery residents in our program. Twenty-two of 24 completed the OSCE. RESULTS: Surveys showed that residents agreed that although learning the PE is important, there is not enough time in clinic to actually observe and critique a resident examining a patient. For the 22 residents (postgraduate year [PGY] 2-5) who participated in the OSCE, the overall score was 66%. Scores were significantly better for the trauma scenario (78%; p < 0.05) than for the shoulder (67%), spine (64%), and knee (59%) encounters. The overall scores for each component of the OSCE were: (1) history 53%; (2) PE 60%; (3) 5-question posttest 64%; and (4) communication skills 90%. CONCLUSIONS: We have exposed a deficiency in the PE knowledge and skills of our residents. Clinic time alone may be insufficient to both teach and learn the MSK PE. The use of a MSK OSCE, while novel in orthopedics, will allow more direct observation of our residents MSK PE skills and also allow us to follow resident skills longitudinally through their training. We hope that our efforts will encourage other programs to assess their PE curriculum and perhaps prompt change.